FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
Lifevantage Corp [ LFVN ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 03/15/2011 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Stock Option (Right to Buy) | $0.75 | 03/15/2011 | A | 610,000 | (1) | 03/14/2021 | Common Stock | 610,000 | $0 | 610,000 | D | ||||
Stock Option (Right to Buy) | $1.2 | 03/15/2011 | A | 500,000 | (2) | 03/14/2021 | Common Stock | 500,000 | $0 | 500,000 | D | ||||
Stock Option (Right to Buy) | $1.75 | 03/15/2011 | A | 500,000 | (3) | 03/14/2021 | Common Stock | 500,000 | $0 | 500,000 | D | ||||
Stock Option (Right to Buy) | $0.8 | 03/15/2011 | D | 80,000 | (4) | 01/20/2021 | Common Stock | 80,000 | $0 | 40,000 | D |
Explanation of Responses: |
1. This option vests on the date of grant with respect to 110,000 shares of common stock and becomes exercisable with respect to 500,000 shares of common stock as of June 30, 2012, only if Mr. Robinson has continuously rendered service to the Company through the applicable vesting date. |
2. This option fully vests and becomes exercisable as of June 30, 2013 only if Mr. Robinson has continuously rendered service to the Company through the applicable vesting date. |
3. This option fully vests and becomes exercisable as of June 30, 2014 only if Mr. Robinson has continuously rendered service to the Company through the applicable vesting date. |
4. In connection with the commencement of his employment as the Company's President and Chief Executive Officer on 3/15/2011, Mr. Robinson agreed to the cancellation and forfeiture of 80,000 unvested shares of common stock underlying the option to purchase 120,000 shares of common stock which was granted to him on 1/20/2011 in his capacity as a non-employee director of the Company. |
/s/ Doug Robinson | 03/15/2011 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |