2020-11-05T18:22:25-06:00 2019-12-31 521446779 JOHNSON LAMBERT LLP 4242 SIX FORKS ROAD SUITE 1500 RALEIGH NC 27609 990 2019-01-01 461056754 CHESAPEAKE EMPLOYERS' INSURANCE COMPANY CHES 4104942000 8722 LOCH RAVEN BOULEVARD TOWSON MD 212862235 FRANCIS LINARDI CHIEF FINANCIAL OFFICER 4104942000 2020-11-05 1 J CALVIN MARKS P01226973 9197196400 34.206.232.202 2020-11-05 18:22:20 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 75F1779BA68A735F9CB0B3115F257B873EEC838E 2019 2021-04-22 16:20:28Z THOMAS PHELAN 8722 LOCH RAVEN BOULEVARD TOWSON MD 212862235 748243593 0 X WWW.CEIWC.COM X 2012 MD CHESAPEAKE EMPLOYERS' INSURANCE COMPANY WAS ESTABLISHED BY STATUTE TO BE THE WORKERS' COMPENSATION INSURER OF LAST RESORT AS WELL AS A COMPETITIVE INSURER IN THE STATE OF MARYLAND. 9 0 297 0 0 0 0 0 215009895 206032392 113383667 137612166 94151 81001 328487713 343725559 17860 12850 0 0 37263569 38083780 0 0 0 201912955 149631369 239194384 187727999 89293329 155997560 2271677738 2378021639 1508257614 1465971919 763420124 912049720 CHESAPEAKE EMPLOYERS' INSURANCE COMPANY WAS ESTABLISHED BY STATUTE TO BE THE WORKERS' COMPENSATION INSURER OF LAST RESORT AS WELL AS A COMPETITIVE INSURER IN THE STATE OF MARYLAND. 0 0 CHESAPEAKE EMPLOYERS' INSURANCE COMPANY HAD OVER 22,000 IN-FORCE POLICIES AND WAS MANAGING MORE THAN 3,450 OPEN CLAIMS AT DECEMBER 31, 2019. 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1971 0 1 297 1 0 0 0 0 0 0 0 0 X 9 0 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X FRANCIS LINARDI 4104942000 8722 LOCH RAVEN BLVD TOWSON MD 212862235 THOMAS PHELAN PRESIDENT & CEO 30.00 10.00 X 574610 0 41400 PAIGE BECK CHIEF INNOVATION OFFICER 30.00 10.00 X 358230 0 35785 KEVIN BINGHAM CHIEF RESULTS OFFICER 30.00 10.00 X 304595 0 53515 FRANK LINARDI CHIEF FINANCIAL OFFICER 30.00 10.00 X 242081 0 28596 WILLIAM SMULYAN MEDICAL CONSULTANT 30.00 10.00 X 228733 0 17395 CARMINE D'ALESSANDRO CHIEF LEGAL OFFICER 30.00 10.00 X 227479 0 30479 SHARON ROWELL CHIEF ADMINISTRATIVE OFFIC 30.00 10.00 X 222300 0 29649 SONG MITCH HE CHIEF INVESTMENT OFFICER 30.00 10.00 X 210102 0 45221 STEPHEN FISHER MEDICAL ADVISOR 30.00 10.00 X 206750 0 15846 RONA FINKELSTEIN SENIOR VICE PRESIDENT 30.00 10.00 X 184179 0 46765 RIAL SIMONS CHIEF ACTUARY 30.00 10.00 X 179630 0 13640 KAMA SCHNEIDER VP OF UNDERWRITING & SAFETY 30.00 10.00 X 179235 0 13619 ROBERT MARSHALL CHIEF RISK OFFICER 30.00 10.00 X 164666 0 25013 LISA KRUSKA VP OF CLAIMS 30.00 10.00 X 162988 0 21966 VINCENT ROCKY GONZALEZ DIRECTOR 1.50 0.50 X 51227 0 3816 LEONARD SCHULER DIRECTOR 1.50 0.50 X 49128 0 13875 MARIA TILDON DIRECTOR 1.50 0.50 X 48258 0 3597 FRANKLIN HAJEK DIRECTOR 1.50 0.50 X 47789 0 3670 WAYNE R GIOIOSO SR VICE CHAIR 1.50 0.50 X X 47554 0 3562 SUZANNE THOMPSON BOARD CHAIR 1.50 0.50 X X 47093 0 27333 LEWIS POWELL DIRECTOR 1.50 0.50 X 36811 0 42948 PAUL V GILL DIRECTOR (TO MAY '19) 1.50 0.50 X 24802 0 15321 MARTIN MADDEN DIRECTOR (FROM JUN '19) 1.50 0.50 X 21792 0 0 PAULA S ETTING DIRECTOR (TO FEB '19) 1.50 0.50 X 9075 0 617 KETURAH HARLEY DIRECTOR (FROM OCT '19) 1.50 0.50 X 7827 0 0 3836934 0 533628 98 0 1 0 EXPRESS SCRIPTS INC ONE EXPRESS WAY MS HQ2E04 ST LOUIS MO 63121 MEDICAL/HEALTH SERVICES 2161211 VGM GROUP INC PO BOX 1860 WATERLOO IA 50704 MEDICAL/HEALTH SERVICES 2147131 UNIVERSITY OF MD MEDICAL SYSTEM CORP 11 S PACA ST STE LL BALTIMORE MD 21201 MEDICAL/HEALTH SERVICES 1620951 JOHNS HOPKINS HOSPITAL PO BOX 418297 BOSTON MA 02241 MEDICAL/HEALTH SERVICES 1116179 BROWN CAPITAL MANAGEMENT 1201 N CALVERT ST BALTIMORE MD 21202 INVESTMENT SERVICES 975054 101 PREMIUMS EARNED 524150 205505614 205505614 INSTALLMENT FEES & NSF CHARGES 900099 526778 526778 206032392 78271180 78271180 463859020 404518034 59340986 59340986 59340986 81001 81001 81001 343725559 206032392 0 137693167 X 12850 3287945 26851696 2212587 3710900 2020652 1565359 356485 5559053 29339200 2318388 3030523 1412339 2572886 379477 189739 2406719 2957760 732781 LOSSES 87396728 TAXES, LICENSES, FEES 8019544 DIVIDENDS 785470 608918 187727999 208512 969024 49389401 68673192 71461482 64004322 40930126 32332647 8880553 8597479 2028237436 2061994062 43757673 57629740 69742681 116153820 2271677738 2378021639 20815750 21974504 96751722 93032307 1390690142 1350965108 1508257614 1465971919 X 763420124 912049720 763420124 912049720 2271677738 2378021639 X 155997560 487798 -7855762 X 0 1 X 1 0 1335400 1335400 14206861 7547682 6659179 25387865 24784965 602900 8597479 LOSSES & LOSS ADJUSTMENT EXPENSES 1155320000 BORROWED MONEY & ACCRUED INTEREST 100230800 PAYABLE FOR SECURITIES LENDING 69896407 DIVIDENDS PAYABLE 24352301 PROVISION FOR REINSURANCE 894000 FUNDS HELD BY COMPANY UNDER REINSURANCE TREATY 271000 DUE TO AFFILIATE 600 1350965108 X 333185244 487798 487798 332697446 11028113 11028113 343725559 179681812 2981926 2981926 176699886 11028113 11028113 187727999 PART X, LINE 2: CHESAPEAKE DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS AS OF DECEMBER 31, 2019. PART XII, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT 2,981,926. 1 COLORECTAL CANCER ALLIANCE 1025 VERMONT AVE NW WASHINGTON DC 20005 860947831 501(C)(3) 12850 GENERAL SUPPORT 1 0 PART I, LINE 2: CHESAPEAKE OCCASIONALLY MAKES SMALL CHARITABLE CONTRIBUTIONS AND GRANTS TO 501(C)(3)S AS A WAY OF GIVING BACK TO THE COMMUNITY. GRANTS ARE REVIEWED AND APPROVED BY AN INTERNAL COMMITTEE. X X 0 1 0 THOMAS PHELAN PRESIDENT & CEO 382600 0 165819 0 26191 0 41400 0 0 0 616010 0 0 0 PAIGE BECK CHIEF INNOVATION OFFICER 272941 0 12180 0 73109 0 35785 0 0 0 394015 0 0 0 KEVIN BINGHAM CHIEF RESULTS OFFICER 295073 0 750 0 8772 0 22400 0 31115 0 358110 0 0 0 FRANK LINARDI CHIEF FINANCIAL OFFICER 217898 0 11279 0 12904 0 14438 0 14158 0 270677 0 0 0 WILLIAM SMULYAN MEDICAL CONSULTANT 217433 0 11280 0 20 0 17395 0 0 0 246128 0 0 0 CARMINE D'ALESSANDRO CHIEF LEGAL OFFICER 198719 0 10166 0 18594 0 15178 0 15301 0 257958 0 0 0 SHARON ROWELL CHIEF ADMINISTRATIVE OFFIC 198403 0 10166 0 13731 0 14348 0 15301 0 251949 0 0 0 SONG MITCH HE CHIEF INVESTMENT OFFICER 199679 0 10423 0 0 0 16569 0 28652 0 255323 0 0 0 STEPHEN FISHER MEDICAL ADVISOR 196577 0 10173 0 0 0 15846 0 0 0 222596 0 0 0 RONA FINKELSTEIN SENIOR VICE PRESIDENT 174296 0 9883 0 0 0 14708 0 32057 0 230944 0 0 0 RIAL SIMONS CHIEF ACTUARY 170403 0 9227 0 0 0 13640 0 0 0 193270 0 0 0 KAMA SCHNEIDER VP OF UNDERWRITING & SAFETY 170235 0 9000 0 0 0 13619 0 0 0 192854 0 0 0 ROBERT MARSHALL CHIEF RISK OFFICER 156073 0 8593 0 0 0 13585 0 11428 0 189679 0 0 0 LISA KRUSKA VP OF CLAIMS 154511 0 8477 0 0 0 10950 0 11016 0 184954 0 0 0 PART I, LINE 4B PAIGE BECK SUPPLEMENTAL NON-QUALIFIED PLAN $16,006 FRANCIS LINARDI SUPPLEMENTAL NON-QUALIFIED PLAN $ 2,500 ROBERT MARSHALL SUPPLEMENTAL NON-QUALIFIED PLAN $ 2,500 FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION'S BYLAWS WERE AMENDED TO PROVIDE FOR DOCUMENTATION OF THE PROCESS FOR POLICYHOLDER ELECTIONS, AND TO PROVIDE CLARIFICATION ON ADMINISTRATIVE BOARD TERMS. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION MEMBERS CONSIST OF THE 9 BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS, WHICH COMPOSE THE MEMBERS OF THE ORGANIZATION, ARE APPOINTED BY THE GOVERNOR OF THE STATE OF MARYLAND AND CONFIRMED BY THE MARYLAND STATE SENATE. FORM 990, PART VI, SECTION A, LINE 7B THE GOVERNOR OF MARYLAND RESERVES THE POWER TO REMOVE A BOARD MEMBER FOR INCOMPETANCE OR MISCONDUCT. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS COMPLETED BY AN EXTERNAL ACCOUNTANT AND THE RETURN IS PROVIDED TO EACH MEMBER OF THE BOARD PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C ALL EMPLOYEES COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE EACH YEAR. ANY INSTANCES OF POTENTIAL CONFLICT ARE REVIEWED BY HUMAN RESOURCES OR THE CHIEF LEGAL OFFICER FOR THE APPROPRIATE RESOLUTION. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE CEO, EXECUTIVES, AND TOP MANAGEMENT POSITIONS ARE DETERMINED UPON THE COMPLETION OF AN ANNUAL EVALUATION AND IS BASED UPON INDIVIDUAL AND COMPANY PERFORMANCE AS WELL AS INDUSTRY CONSIDERATIONS AND OTHER BENCHMARK DATA. COMPENSATION FOR THE CEO IS DETERMINED BY THE BOARD OF DIRECTORS AND COMPENSATION FOR OTHER EXECUTIVES AND TOP MANAGEMENT POSITIONS ARE DETERMINED BY THE CEO. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND CERTAIN FINANCIAL INFORMATION IS AVAILABLE UPON REQUEST AND CERTAIN FINANCIAL INFORMATION IS AVAILABLE ON THE ORGANIZATION'S WEBSITE. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICES 29,339,200. FORM 990, PART XI, LINE 9: CHANGE IN NON ADMITTED ASSETS -3,979,836. BAD DEBT -2,981,926. CHANGE IN PROVISION FOR REINSURANCE -894,000. INJURED WORKERS INSURANCE FUND 8722 LOCH RAVEN BOULEVARD TOWSON MD 212862226 522127565 STATE SPONSORED WORKMENS' COMPENSATION INSURANCE MD 501(C)27 0 STATE OF MARYLAND 100 STATE CIRCLE ANNAPOLIS MD 21401 522006962 STATE GOVERNMENT MD 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 INJURED WORKERS INSURANCE FUND S 11144797 FAIR VALUE INJURED WORKERS INSURANCE FUND Q 2701506 FAIR VALUE INJURED WORKERS INSURANCE FUND D 1161155 FAIR VALUE