Initial Statement of Beneficial Ownership (3)
June 23 2021 - 12:12PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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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1. Name and Address of Reporting Person
*
Cooley Matthew |
2. Date of Event Requiring Statement (MM/DD/YYYY)
6/22/2021
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3. Issuer Name and Ticker or Trading Symbol
Lifevantage Corp [LFVN]
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(Last)
(First)
(Middle)
3300 TRIUMPH BLVD, SUITE 700 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner ___X___ Officer (give title below) _____ Other (specify below) Chief Operating Officer / |
(Street)
LEHI, UT 84043
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock (1) | 30000 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
(1) | These restricted stock units ("RSUs") were acquired pursuant to a restricted stock award granted May 24, 2021, which vests in three equal annual installments on each of May 24, 2022, May 24, 2023, and May 24, 2024, subject to continued service with the Company. These RSUs expire on May 24, 2031. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Cooley Matthew 3300 TRIUMPH BLVD, SUITE 700 LEHI, UT 84043 |
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| Chief Operating Officer |
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Signatures
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/s/ Matthew Cooley | | 6/22/2021 |
**Signature of Reporting Person | Date |
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