AMENDMENT NO. 4 TO THE ---------------------- MOORE MEDICAL CORP. DEFINED BENEFIT PENSION PLAN AND TRUST --------------------------------------

                                                                   Exhibit 10.5D

                            AMENDMENT NO. 4 TO THE
                            ----------------------
                              XXXXX MEDICAL CORP.
                    DEFINED BENEFIT PENSION PLAN AND TRUST
                    --------------------------------------


The Xxxxx Medical Corp. Defined Benefit Pension Plan and Trust Agreement is
amended, effective August 18, 1999, as follows:

1.   Section 1.1, Trustees, is deleted in its entirety and the following Section
     -----------  --------                                               -------
     1.1, Trustees, is substituted therefor:
     ---  --------

     "1.1 TRUSTEES

            The following are hereby appointed to act as Trustees hereunder:



                        NAME                                         ADDRESS
                        ----                                         -------
                                                            
     (a)  The President of Xxxxx Medical Corp.                 000 Xxxx Xxxxxx Xxxxx,
                                                               Xxx Xxxxxxx, XX 00000

     (b)  An Executive Vice President of                       000 Xxxx Xxxxxx Xxxxx,
          Xxxxx Medical Corp., as designed by                  Xxx Xxxxxxx, XX 00000
          The President from time to time.

     (c)  An Senior Vice President of                          000 Xxxx Xxxxxx Xxxxx
          Xxxxx Medical Corp., as designated by the            Xxx Xxxxxxx, XX 00000
          President from time to time


2.   The remainder of the Xxxxx Medical Corp. Defined Benefit Pension Plan and
     Trust Agreement is ratified and affirmed.

IN WITNESS WHEREOF, the parties have executed this amendment this _______ day of
November, 1999.

                                        XXXXX MEDICAL CORP.

                                        By  /s/ Xxxxx X. Xxxxxx
                                          ---------------------
                                          Its President

                                            /s/ Xxxxx X. Xxxxxx
                                          ---------------------
                                          Xxxxx X. Xxxxxx, (President), Trustee


                                            /s/ Xxxxxxx X. Xxxxxxxxx
                                          --------------------------
                                          Xxxxxxx X. Xxxxxxxxx,
                                          (Executive Vice President -
                                          Operations), Trustee


                                            /s/ Xxxxxx X. Xxxxxxx
                                          -----------------------
                                          Xxxxxx X. Xxxxxxx,
                                          (Senior Vice President-Finance),
                                          Trustee