3 1 0001.txt FORM 3 =============================================================================== Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. /------------------------------/ / OMB APPROVAL / /------------------------------/ \ / OMB Number: 3235-0104 / EDIT OR DELETE AS NECESSARY---------------- / Expires: October 31, 2001 / / / Estimated average burden / / hours per response...... 0.5 / /------------------------------/ +--------+ | 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) -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* Simpson, James R. ---------------------------------------------------------------------------- (Last) (First) (Middle) c/o Moore Medical Corp. ---------------------------------------------------------------------------- (Street) 389 John Downey Drive, New Britain CT 06050 ---------------------------------------------------------------------------- (City) (State) (Zip) 2. Date of Event Requiring Statement (Month/Day/Year) 3/5/01 -------------- 3. IRS Identification Number of Reporting Person if an Entity (Voluntary) -------------- 4. Issuer Name and Ticker or Trading Symbol MMD ----------------------------------- 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) Dirctor X Officer 10% Owner Other --- ---(give title below) --- ---(specify below) Executive Vice President - Chief Financial Officer ---------------------------------------------------------------------------- 6. If Amendment, Date of Original (Month/Day/Year) ---------------------------- 7. 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 BENEFICIALLY OWNED
-------------------------------------------------------------------------------- 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) -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- --------------------------------------------------------------------------------
-------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- TABLE II--DERIVATIVE SECURITIES BENEFICIALLY OWNED (e.g., puts, calls, warrants, options, convertible securities)
------------------------------------------------------------------------------------------------------------------------------------ 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 ------------------------------------------------------------------------------------------------------------------------------------ Non-qualified Stock Option 3/5/02 3/4/06(1) Common Stock 30,000 $ 7.50 D ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ -----------------------------------------------------------------------------------------------------------------------------------
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 in the event of a "change of position" and termination of employment following a "change of control" under the Issuer's Change of Control/Change of Position Payment Plan. /s/ James R. Simpson 4/10/01 ------------------------------- ----------------- **Signature of Reporting Person Date James R. Simpson * 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.