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  5. MEDSOURCE USA, INC.

MEDSOURCE USA, INC.

Company Details

Entity Name: MEDSOURCE USA, INC.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 16 Jan 2001
Company Number: CORP_61443444
File Number: 61443444
Type of Business: All Inclusive Purpose
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MEDSOURCE USA, INC. 401(K) PROFIT SHARING PLAN 2023 371408060 2024-07-02 MEDSOURCE USA, INC. 62
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621610
Sponsor’s telephone number 3096647930
Plan sponsor’s address 3002 GILL STREET, BLOOMINGTON, IL, 61704
MEDSOURCE USA, INC. 401(K) PROFIT SHARING PLAN 2022 371408060 2023-08-15 MEDSOURCE USA, INC. 58
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621610
Sponsor’s telephone number 3096647930
Plan sponsor’s address 3002 GILL STREET, BLOOMINGTON, IL, 61704
MEDSOURCE USA, INC. 401(K) PROFIT SHARING PLAN 2021 371408060 2022-10-14 MEDSOURCE USA, INC. 59
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621610
Sponsor’s telephone number 3096647930
Plan sponsor’s address 3002 GILL STREET, BLOOMINGTON, IL, 61704

Signature of
Role Plan administrator
Date 2022-10-10
Name of individual signing CASSIE ROSALEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-10-10
Name of individual signing CASSIE ROSALEZ
Valid signature Filed with authorized/valid electronic signature
MEDSOURCE USA, INC. 401(K) PROFIT SHARING PLAN 2020 371408060 2021-10-14 MEDSOURCE USA, INC. 50
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621610
Sponsor’s telephone number 3096647930
Plan sponsor’s address 3002 GILL STREET, BLOOMINGTON, IL, 61704

Signature of
Role Plan administrator
Date 2021-10-12
Name of individual signing CASSANDRA ROSALEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-10-12
Name of individual signing CASSANDRA ROSALEZ
Valid signature Filed with authorized/valid electronic signature
MEDSOURCE USA, INC. 401(K) PROFIT SHARING PLAN 2019 371408060 2020-10-12 MEDSOURCE USA, INC. 82
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621610
Sponsor’s telephone number 3096647930
Plan sponsor’s address 3002 GILL STREET, BLOOMINGTON, IL, 61704

Signature of
Role Plan administrator
Date 2020-10-12
Name of individual signing CASSANDRA ROSALEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-10-12
Name of individual signing CASSANDRA ROSALEZ
Valid signature Filed with authorized/valid electronic signature
MEDSOURCE USA, INC. 401(K) PROFIT SHARING PLAN 2018 371408060 2019-10-15 MEDSOURCE USA, INC. 85
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621610
Sponsor’s telephone number 3096647930
Plan sponsor’s address 3002 GILL STREET, BLOOMINGTON, IL, 61704

Signature of
Role Plan administrator
Date 2019-10-15
Name of individual signing CASSANDRA ROSALEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-10-15
Name of individual signing CASSANDRA ROSALEZ
Valid signature Filed with authorized/valid electronic signature
MEDSOURCE USA, INC. 401(K) PROFIT SHARING PLAN 2017 371408060 2018-10-15 MEDSOURCE USA, INC. 84
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621610
Sponsor’s telephone number 3096647930
Plan sponsor’s address 3002 GILL STREET, BLOOMINGTON, IL, 61704
MEDSOURCE USA, INC. 401(K) PROFIT SHARING PLAN 2016 371408060 2017-10-16 MEDSOURCE USA, INC. 72
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621610
Sponsor’s telephone number 3096647930
Plan sponsor’s address 3002 GILL STREET, BLOOMINGTON, IL, 61704

Signature of
Role Plan administrator
Date 2017-10-16
Name of individual signing MERRY ANN ROTH
Valid signature Filed with authorized/valid electronic signature
MEDSOURCE 401(K) PLAN 2015 371408060 2016-09-23 MEDSOURCE USA, INC 63
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621610
Sponsor’s telephone number 3093923344
Plan sponsor’s address 3002 GILL ST., BLOOMINGTON, IL, 61704

Signature of
Role Plan administrator
Date 2016-09-23
Name of individual signing MERRY ANN ROTH
Valid signature Filed with authorized/valid electronic signature
MEDSOURCE 401(K) PLAN 2014 371408060 2015-09-03 MEDSOURCE USA, INC 61
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621610
Sponsor’s telephone number 3093923344
Plan sponsor’s address 3002 GILL ST., BLOOMINGTON, IL, 61704

Signature of
Role Plan administrator
Date 2015-09-03
Name of individual signing MERRY ANN ROTH
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
CLAYTON J PATTERSON, 51 COUNTRY CLUB PL, BLOOMINGTON, 61701, MC LEAN Agent 2022-03-14

President

Name and Address Role
CRAIG A. LISSNER, 3002 GILL ST., BLOOMINGTON IL 61704 President

Secretary

Name and Address Role
ERIC ROHDE, 3002 GILL ST., BLOOMINGTON IL 61704 Secretary

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMM No data Voting Rights 1000 1000000 No data

Related by officers

CLAYTON J PATTERSON, 51 COUNTRY CLUB PL, BLOOMINGTON, 61701, MC LEAN

MALLINGHAM HOMEOWNERS ASSOCIATION, INC. KRUG PROPERTIES, LLC JJE HOLDINGS, LLC LAKEWOOD HILLCREST HOMEOWNER'S ASSOCIATION

Related by address

No related companies by address

Date of last update: 16 Jan 2025

Sources: Illinois Office of the Secretary of State

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