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| FORM 3 | U.S. SECURITIES AND EXCHANGE COMMISSION
+--------+ WASHINGTON, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934,
Section 17(a) of the Public Utility Holding Company Act of 1935 or
Section 30(f) of the Investment Company Act of 1940
(Print or Type Responses)
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1. Name and Address of Reporting Person*
Roffers, Chad A.
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(Last) (First) (Middle)
c/o Moore Medical Corp.
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(Street)
389 John Downey Drive, New Britain CT 06050
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(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year) 9/12/00
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3. IRS Identification Number of Reporting Person if an Entity
(Voluntary)
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4. Issuer Name and Ticker or Trading Symbol MMD
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5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
Director X Officer 10% Owner Other
--- ---(give title below) --- --- (specify below)
Senior Executive Vice President - e-Business & Emerging Channels
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6. If Amendment, Date of Original (Month/Day/Year)
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7. Individual or Joint Group Filing (Check Applicable Line)
X Form Filed by One Reporting Person
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Form filed by More than One Reporting Person
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TABLE I--NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
<TABLE>
<CAPTION>
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1. Title 2. Amount of 3. Ownership Form: 4. Nature of
of Securities Bene- Direct (D) or Indirect Bene-
Security ficially Owned Indirect (I) ficial Ownership
(Instr. 4) (Instr. 4) (Instr. 5) (Instr. 5)
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<S> <C> <C> <C>
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</TABLE>
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TABLE II--DERIVATIVE SECURITIES BENEFICIALLY OWNED
(e.g., puts, calls, warrants, options, convertible securities)
<TABLE>
<CAPTION>
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1. Title of Derivative 2. Date Exer- 3. Title and Amount of Securities 4. Conversion 5. Ownership 6. Nature of In-
Security (Instr. 4) cisable and Underlying Derivative Security or Form of direct Bene-
Expiration (Instr. 4) Exercise Derivative ficial
Date Price Security: Ownership
(Month/Day/ of Direct (D) (Instr. 5)
Year) Derivative or In-
---------------------------------------------------- Security direct (I)
Date Expira- Amount or (Instr. 5)
Exer- tion Title Number of
cisable Date Shares
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<S> <C> <C> <C> <C> <C> <C> <C>
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Non-qualified Stock Option 9/5/01 9/4/05/(1) Common Stock 50,000 $7.25 D
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
Explanation of Responses:
(1) Becomes exercisable in four equal cumulative annual installments
commencing one year from the date of grant, subject to acceleration of
50% of non-vested installments on a "change of control" and the
Reporting Person's termination of employment following a "change of
position" under the Issuer's Change of Control/Change of Position
Payment Plan.
9/21/00
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**Signature of Reporting Person Date
Chad A. Roffers
* If the form is filed by more than one reported person, see Instruction
5(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.