Form 5500 · Employee benefit plan · ROOSEVELT, UT
UINTAH BASIN MEDICAL CENTER, INC.
UINTAH BASIN MEDICAL CENTER, INC. of ROOSEVELT, UT files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is GALLAGHER BENEFIT SERVICES. Coverage is written through SELECTHEALTH and 4 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 87-0276435 · plan 501 · as of Aug 2026
Plan brief
Schedule A lists 5 insured contracts covering health, vision, life and disability; the largest, with SELECTHEALTH, covers 1,450 people.
Reported premium across the insured contracts is $13,735,954, with $290,394 in disclosed broker commissions — about 2.1% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
GALLAGHER BENEFIT SERVICES is the broker of record on 3 of the 5 contracts; the rest name a different broker or none.
5 carriers appear on the filing — SELECTHEALTH, USABLE LIFE, COMBINED INSURANCE COMPANY OF AMERICA and COMBINED INSURANCE COMPANY among them — with SELECTHEALTH writing the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| SELECTHEALTH | Health, Vision | 1,450 | December | $12,986,739 | $187,131 |
| COMBINED INSURANCE COMPANY OF AMERICA | — | 578 | December | $140,632 | $45,202 |
| USABLE LIFE | Life, Disability | 712 | December | $543,147 | $36,704 |
| COMBINED INSURANCE COMPANY | — | 96 | December | $46,398 | $18,121 |
| PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | — | 88 | December | $19,038 | $3,236 |
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