SEC Form 4
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*
LEVITAN DAN

(Last) (First) (Middle)
C/O MAVERON LLC
505 FIFTH AVENUE SOUTH, SUITE 600

(Street)
SEATTLE WA 98104

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
DRUGSTORE COM INC [ DSCM ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
09/17/2003
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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
Common Stock 09/17/2003 J(1) 500,000 D $0(5) 1,592,246(4) I By Maveron
Common Stock 09/17/2003 J(2) 14,840 A $0(5) 14,840 D
Common Stock 09/17/2003 J(3) 12,393 A $0(5) 27,233 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Explanation of Responses:
1. On September 17, 2003, Maveron Equity Partners, L.P. ("Maveron") made an in-kind distribution of 500,000 shares of common stock of drugstore.com, inc. ("Common Stock") to its partners (the "Maveron Distribution"). The Maveron Distribution was made to the partners of Maveron in proportion to their partnership interests. Mr. Levitan is one of two members of a limited liability company that serves as a general partner of Maveron and, as such, may be deemed to be a beneficial owner of the Maveron shares. Mr. Levitan disclaims beneficial ownership of Common Stock held by Maveron, except to the extent of his pecuniary interest in those shares.
2. Mr. Levitan, a limited partner of Maveron, received 14,840 shares of Common Stock in the Maveron Distribution.
3. On September 17, 2003, Maveron General Partner LLC made an in-kind distribution of Common Stock to its members (the "LLC Distribution") . The LLC Distribution was made to the members of Maveron General Partner LLC in proportion to their membership interests. Mr. Levitan, a member of Maveron General Partner LLC, received 12,393 shares of Common Stock in the LLC Distribution.
4. Represents the shares of Common Stock held by Maveron after the Maveron Distribution.
5. No price is reported becasue the transactions represent in-kind distributions of Common Stock.
Dan Levitan 09/19/2003
** 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).
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