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  5. MEDSOURCE, INC.

MEDSOURCE, INC.

Company Details

Name: MEDSOURCE, INC.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 14 Jul 1998 (27 years ago)
Identification Number: 000101523
ZIP code: 02878
County: Newport County
Principal Address: 86 DANIEL T. CHURCH ROAD, TIVERTON, RI, 02878, USA
Purpose: MEDICAL PRODUCT DISTRIBUTION
NAICS: 423450 - Medical, Dental, and Hospital Equipment and Supplies Merchant Wholesalers
Historical names: Orthopedic Rehab Resources, Incorporated

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MEDSOURCE, INC. 401(K) PLAN 2023 050500113 2024-07-20 MEDSOURCE, INC. 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 339110
Sponsor’s telephone number 4016242400
Plan sponsor’s address 548 MAIN RD, TIVERTON, RI, 028781350

Signature of
Role Plan administrator
Date 2024-07-20
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature
MEDSOURCE, INC. 401(K) PLAN 2022 050500113 2023-04-11 MEDSOURCE, INC. 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 339110
Sponsor’s telephone number 4016242400
Plan sponsor’s address 1204 FISH ROAD, TIVERTON, RI, 028781350

Signature of
Role Plan administrator
Date 2023-04-11
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-04-11
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature
MEDSOURCE, INC. 401(K) PLAN 2021 050500113 2022-04-11 MEDSOURCE, INC. 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 339110
Sponsor’s telephone number 4016242400
Plan sponsor’s address 86 DANIEL T CHURCH ROAD, TIVERTON, RI, 028781350

Signature of
Role Plan administrator
Date 2022-04-11
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-04-11
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature
MEDSOURCE, INC. 401(K) PLAN 2020 050500113 2021-04-15 MEDSOURCE, INC. 30
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 339110
Sponsor’s telephone number 4016242400
Plan sponsor’s address 86 DANIEL T CHURCH ROAD, TIVERTON, RI, 028781350

Signature of
Role Plan administrator
Date 2021-04-15
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-04-15
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature
MEDSOURCE, INC. 401(K) PLAN 2020 050500113 2021-04-15 MEDSOURCE, INC. 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 339110
Sponsor’s telephone number 4016242400
Plan sponsor’s address 86 DANIEL T CHURCH ROAD, TIVERTON, RI, 028781350

Signature of
Role Plan administrator
Date 2021-04-15
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-04-15
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature
MEDSOURCE, INC. 401(K) PLAN 2019 050500113 2020-06-22 MEDSOURCE, INC. 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 339110
Sponsor’s telephone number 4016242400
Plan sponsor’s address 548 MAIN RD, TIVERTON, RI, 028781350

Signature of
Role Plan administrator
Date 2020-06-22
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-06-22
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature
MEDSOURCE, INC. 401(K) PLAN 2018 050500113 2019-07-17 MEDSOURCE, INC. 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 339110
Sponsor’s telephone number 4016242400
Plan sponsor’s address 548 MAIN RD, TIVERTON, RI, 028781350

Signature of
Role Plan administrator
Date 2019-07-17
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature
MEDSOURCE, INC. 401(K) PLAN 2017 050500113 2018-07-25 MEDSOURCE, INC. 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 339110
Sponsor’s telephone number 4016242400
Plan sponsor’s address 548 MAIN RD, TIVERTON, RI, 028781350

Signature of
Role Plan administrator
Date 2018-07-25
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature
MEDSOURCE, INC. 401(K) PLAN 2016 050500113 2017-07-10 MEDSOURCE, INC. 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 339110
Sponsor’s telephone number 4016242400
Plan sponsor’s address 548 MAIN RD, TIVERTON, RI, 028781350

Signature of
Role Plan administrator
Date 2017-07-10
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-10
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature
MEDSOURCE, INC. 401(K) PLAN 2015 050500113 2016-07-20 MEDSOURCE, INC. 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 339110
Sponsor’s telephone number 4016242400
Plan sponsor’s address 548 MAIN RD, TIVERTON, RI, 028781350

Signature of
Role Plan administrator
Date 2016-07-20
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-07-20
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/07/24/20150724131101P040109689815001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 339110
Sponsor’s telephone number 4016242400
Plan sponsor’s address 548 MAIN RD, TIVERTON, RI, 028781350

Signature of
Role Plan administrator
Date 2015-07-24
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-24
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/07/31/20140731140723P030025605805001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 339110
Sponsor’s telephone number 4016242400
Plan sponsor’s address 548 MAIN RD, TIVERTON, RI, 028781350

Signature of
Role Plan administrator
Date 2014-07-31
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-31
Name of individual signing KEVIN BOULAY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
KEVIN BOULAY Agent 86 DANIEL T. CHURCH ROAD, TIVERTON, RI, 02878, USA

PRESIDENT

Name Role Address
KEVIN BOULAY PRESIDENT 86 DANIEL T. CHURCH ROAD TIVERTON, RI 02878- USA

Events

Type Date Old Value New Value
Name Change 1998-09-15 Orthopedic Rehab Resources, Incorporated MEDSOURCE, INC.

Filings

Number Name File Date
202448561280 Annual Report 2024-03-12
202332589590 Annual Report 2023-04-07
202220885940 Annual Report 2022-07-09
202220046530 Revocation Notice For Failure to File An Annual Report 2022-06-27
202193905780 Annual Report 2021-03-12
202036379370 Annual Report 2020-03-13
201988637260 Annual Report 2019-03-14
201860402250 Annual Report 2018-03-16
201738111910 Annual Report 2017-03-15
201694143080 Annual Report 2016-03-10

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 08 Oct 2024

Sources: Rhode Island Department of State

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