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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
Historical names: Orthopedic Rehab Resources, Incorporated

Industry & Business Activity

NAICS

423450 Medical, Dental, and Hospital Equipment and Supplies Merchant Wholesalers

This industry comprises establishments primarily engaged in the merchant wholesale distribution of professional medical equipment, instruments, and supplies (except ophthalmic equipment and instruments and goods used by ophthalmologists, optometrists, and opticians). Learn more at the U.S. Census Bureau

Companies doing Medical, dental, and hospital equipment and supplies merchant wholesalers

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

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
2999598301 2021-01-21 0165 PPS 86 Daniel T Church Rd, Tiverton, RI, 02878-4440
Loan Status Date 2021-07-21
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 150000
Loan Approval Amount (current) 150000
Undisbursed Amount 0
Franchise Name -
Lender Location ID 65657
Servicing Lender Name BankNewport
Servicing Lender Address 10 Washington Sq, NEWPORT, RI, 02840-2948
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Tiverton, NEWPORT, RI, 02878-4440
Project Congressional District RI-01
Number of Employees 10
NAICS code 423450
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 65657
Originating Lender Name BankNewport
Originating Lender Address NEWPORT, RI
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 150608.22
Forgiveness Paid Date 2021-06-23
3815737409 2020-05-08 0165 PPP 86 Daniel T Church Rd, TIVERTON, RI, 02878-4440
Loan Status Date 2021-08-27
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 177100
Loan Approval Amount (current) 177100
Undisbursed Amount 0
Franchise Name -
Lender Location ID 65657
Servicing Lender Name BankNewport
Servicing Lender Address 10 Washington Sq, NEWPORT, RI, 02840-2948
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address TIVERTON, NEWPORT, RI, 02878-4440
Project Congressional District RI-01
Number of Employees 13
NAICS code 423450
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 65657
Originating Lender Name BankNewport
Originating Lender Address NEWPORT, RI
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 178613.84
Forgiveness Paid Date 2021-03-17

Related by officers

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Date of last update: 09 Apr 2025

Sources: Rhode Island Department of State

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