2016-11-14T12:07:29-06:00 2015-12-31 521446779 JOHNSON LAMBERT LLP 4242 SIX FORKS RD STE 1500 RALEIGH NC 27609 990 2015-01-01 461056754 CHESAPEAKE EMPLOYERS' INSURANCE COMPANY CHES 8722 LOCH RAVEN BOULEVARD TOWSON MD 212862235 FRANCIS LINARDI CHIEF FINANCIAL OFFICER 4104942000 2016-11-14 1 JOHN HUSKINS P01081531 9197196400 2016-11-14 2015 2017-02-10 21:41:12Z THOMAS PHELAN 8722 LOCH RAVEN BOULEVARD TOWSON MD 212862235 707618725 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 9 218 0 6877 4877 0 0 228711230 234147028 93507680 87346245 653179 2501 322872089 321495774 115000 397180 0 0 50568433 38064330 0 0 0 222273780 197628759 272957213 236090269 49914876 85405505 1998234981 2070053091 1606143006 1604778225 392091975 465274866 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 21,500 IN-FORCE POLICIES AND WAS MANAGING MORE THAN 4,400 OPEN CLAIMS AT DECEMBER 31, 2015. 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 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 1960 0 1 218 1 1 1 0 0 0 0 0 X 9 9 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X FRANCIS LINARDI 4104942000 8722 LOCH RAVEN BLVD TOWSON MD 212862235 JOSEPH M COALE CHAIRMAN 1.50 0.50 X X 41417 0 3313 CHARLES H DANKMEYER JR VICE CHAIRMAN 1.50 0.50 X X 40794 0 3264 VINCENT ROCKY GONZALEZ TREASURER 1.50 0.50 X X 40917 0 2990 WAYNE R GIOIOSO SR SECRETARY 1.50 0.50 X X 38987 0 3153 PAUL V GILL DIRECTOR 1.50 0.50 X 32117 0 28060 LEWIS C POWELL DIRECTOR 1.50 0.50 X 29296 0 32336 LEONARD SCHULER DIRECTOR 1.50 0.50 X 35761 0 10285 SUZANNE THOMPSON DIRECTOR (FROM JUN '15) 1.50 0.50 X 15018 0 9315 MARIA TILDON DIRECTOR 1.50 0.50 X 34624 0 2770 IVORY E TUCKER DIRECTOR (TO JUN '15) 1.50 0.50 X 18917 0 1490 THOMAS PHELAN PRESIDENT & CEO 30.00 10.00 X 354625 0 39200 TIMOTHY MICHELS CHIEF OPERATING OFFICER 30.00 10.00 X 208237 0 55494 PAIGE BECK CHIEF ADMINISTRATIVE OFFICER 30.00 10.00 X 219378 0 53029 FRANCIS J LINARDI JR CHIEF FINANCIAL OFFICER 30.00 10.00 X 196494 0 29722 DENNIS CARROLL GENERAL COUNSEL 30.00 10.00 X 239989 0 45118 SONG MITCHELL HE CHIEF INVESTMENT OFFICER 30.00 10.00 X 169210 0 56685 DONNA C WILSON SENIOR VICE PRESIDENT 30.00 10.00 X 172159 0 38042 RONA FINKELSTEIN SENIOR VICE PRESIDENT 30.00 10.00 X 168477 0 40403 PAULETTE LUNDY VICE PRESIDENT 30.00 10.00 X 165350 0 14677 SHARON ROWELL ASSISTANT VICE PRESIDENT 30.00 10.00 X 156366 0 23519 RIAL SIMONS CHIEF ACTUARY 30.00 10.00 X 155540 0 15720 JERRY LANDSMAN DIRECTOR OF SIU 30.00 10.00 X 169934 0 18610 J JOSEPH CURRAN JR ASSISTANT VICE PRESIDENT 30.00 10.00 X 151050 0 11878 ROBERT MARSHALL VICE PRESIDENT 30.00 10.00 X 149403 0 25250 CARMINE D'ALESSANDRO VICE PRESIDENT 30.00 10.00 X 145744 0 23524 LISA KRUSKA VICE PRESIDENT 30.00 10.00 X 145235 0 19459 3295039 0 607306 64 0 1 0 EXPRESS SCRIPTS INC ONE EXPRESS WAY MS HQ2E04 ST LOUIS MO 63121 MEDICAL/HEALTH SERVICES 4919840 VGM GROUP INC PO BOX 1860 WATERLOO IA 50704 MEDICAL/HEALTH SERVICES 2104990 UNIVERSITY OF MD MEDICAL SYSTEM CORP 11 S PACA ST STE LL BALTIMORE MD 21201 MEDICAL/HEALTH SERVICES 1650585 ASSET ALLOCATION & MANAGEMENT COMPANY LL 30 W MONROE 3RD FLOOR CHICAGO IL 60603 INVESTMENT SERVICES 1303369 UNION MEMORIAL HOSPITAL 201 EAST UNIVERSITY PARKWAY BALTIMORE MD 21218 MEDICAL/HEALTH SERVICES 1152492 129 PREMIUMS EARNED 524150 233490309 233490309 INSTALLMENT FEES 900099 438165 438165 NSF CHARGES 900099 218554 218554 234147028 63143609 6877 63136732 410309404 16183 386000222 122729 24309182 -106546 24202636 24202636 2501 2501 2501 321495774 234149529 6877 87339368 X 397180 3042255 26988946 2118996 3898257 2015876 1173688 4315564 33403710 2189521 2908093 1094793 2433383 405243 202622 4676962 842838 LOSSES 132890260 TAXES, LICENSES, FEES 9026004 2066078 236090269 5389433 9072984 69746020 134782047 78025388 79217971 35369485 25411221 11819751 9958264 1590727855 1587109522 76204289 81457059 166322245 168455244 1998234981 2070053091 16853783 17414121 266530 108038161 107300597 1481251062 1479796977 1606143006 1604778225 X 390091975 463274866 2000000 2000000 392091975 465274866 1998234981 2070053091 X 85405505 -10984254 -1238360 X 0 1 X 1 0 1335400 1335400 14206861 6599198 7607663 19827224 18812023 1015201 9958264 SECURITIES LENDING REINVESTED COLLATERAL ASSETS 140838611 INVESTMENT INCOME, DUE AND ACCRUED 11192614 RECEIVABLES FROM AFFILIATE 11156464 RECEIVABLES FOR SECURITIES 3598909 FUND HELD BY REINSURED COMPANIES 1111130 OTHER ASSETS 503998 AMOUNTS RECEIVABLE FOR TPA SERVICES 53518 168455244 LOSSES 1231359000 PAYABLE FOR SECURITIES LENDING 140838611 LOSS ADJUSTMENT EXPENSES 106961000 DIVIDENDS 317366 FUNDS HELD BY COMPANY UNDER REINSURANCE TREATY 258000 PROVISION FOR REINSURANCE 63000 1479796977 303770376 -10984254 -10984254 314754630 6644456 96688 6741144 321495774 229349125 0 229349125 6644456 96688 6741144 236090269 PART XI, LINE 4B - OTHER ADJUSTMENTS: MISCELLANEOUS REVENUE RECLASS 96,688. PART XII, LINE 4B - OTHER ADJUSTMENTS: MISCELLANEOUS REVENUE RECLASS 96,688. 1 SINAI HOSPITAL OF BALTIMORE INC 2401 W BELVEDERE AVE BALTIMORE MD 21215 520486540 501(C)(3) 397180 SINAI OCCUPATIONAL ACCELERATED RECOVERY PROGRAM 1 PART I, LINE 2: THE ORGANIZATION IS DEDICATED TO THE PREVENTION AND CARE OF OCCUPATIONAL INJURY AND HAS HELPED FUND SOAR TO ENHANCE THE CARE, RECOVERY, REHABILITATION, AND RETURN TO WORK FOR INJURED WORKERS. THE ORGANIZATION HAS PROCEDURES IN PLACE TO MONITOR THE PROGRESS AND FINANCIAL ASPECTS OF THE GRANT. THE GRANTEE SUBMITS AN ANNUAL REPORT ON THE ACHIEVEMENTS AND OUTCOMES OF THE PROGRAM FOR THE PREVIOUS YEAR, AS WELL AS THE ANTICIPATED USE AND BUDGET FOR THE UPCOMING FISCAL YEAR. THE ORGANIZATION RECEIVES QUARTERLY EMAIL UPDATES ON PROGRESS AND MEETS ONCE PER YEAR IN-PERSON WITH THE GRANTEE. PROGRESS DATA IS COMPILED BY THE GRANTEE'S CASE MANAGER WITH INPUT FROM VARIOUS MEDICAL PERSONNEL. THE ORGANIZATION RESERVES THE RIGHT TO WITHHOLD ANY GRANT PAYMENTS IF THE ENTITY FAILS TO COMPLY WITH ANY WARRANTIES OR REPORTS. X 0 1 0 THOMAS PHELAN PRESIDENT & CEO 347600 0 0 0 7025 0 39200 0 0 0 393825 0 0 0 TIMOTHY MICHELS CHIEF OPERATING OFFICER 199497 0 0 0 8740 0 41208 0 14286 0 263731 0 0 0 PAIGE BECK CHIEF ADMINISTRATIVE OFFICER 204488 0 0 0 14890 0 38976 0 14053 0 272407 0 0 0 FRANCIS J LINARDI JR CHIEF FINANCIAL OFFICER 189388 0 0 0 7106 0 15982 0 13740 0 226216 0 0 0 DENNIS CARROLL GENERAL COUNSEL 236973 0 0 0 3016 0 19519 0 25599 0 285107 0 0 0 SONG MITCHELL HE CHIEF INVESTMENT OFFICER 144210 0 25000 0 0 0 12030 0 44655 0 225895 0 0 0 DONNA C WILSON SENIOR VICE PRESIDENT 172159 0 0 0 0 0 14228 0 23814 0 210201 0 0 0 RONA FINKELSTEIN SENIOR VICE PRESIDENT 168477 0 0 0 0 0 14187 0 26216 0 208880 0 0 0 PAULETTE LUNDY VICE PRESIDENT 165350 0 0 0 0 0 13600 0 1077 0 180027 0 0 0 SHARON ROWELL ASSISTANT VICE PRESIDENT 148707 0 0 0 7659 0 9233 0 14286 0 179885 0 0 0 RIAL SIMONS CHIEF ACTUARY 154340 0 0 0 1200 0 9622 0 6098 0 171260 0 0 0 JERRY LANDSMAN DIRECTOR OF SIU 134018 0 0 0 35916 0 10039 0 8571 0 188544 0 0 0 J JOSEPH CURRAN JR ASSISTANT VICE PRESIDENT 148472 0 0 0 2578 0 11878 0 0 0 162928 0 0 0 ROBERT MARSHALL VICE PRESIDENT 149403 0 0 0 0 0 14579 0 10671 0 174653 0 0 0 CARMINE D'ALESSANDRO VICE PRESIDENT 145744 0 0 0 0 0 9238 0 14286 0 169268 0 0 0 LISA KRUSKA VICE PRESIDENT 145235 0 0 0 0 0 9174 0 10285 0 164694 0 0 0 PART I, LINE 4B TIMOTHY MICHELS SUPPLEMENTAL NON-QUALIFIED PLAN $29,596 PAIGE BECK SUPPLEMENTAL NON-QUALIFIED PLAN $27,364 FRANCIS LINARDI SUPPLEMENTAL NON-QUALIFIED PLAN $5,000 ROBERT MARSHALL SUPPLEMENTAL NON-QUALIFIED PLAN $5,000 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 11 THE 990 TAX RETURN IS COMPLETED BY AN EXTERNAL ACCOUNTANT AND THE RETURN IS REVIEWED BY MANAGEMENT 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 GENERAL COUNSEL 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 COMMISSIONS 24,180,188. OTHER FEES FOR SERVICES 9,223,522. FORM 990, PART XI, LINE 9: CHANGE IN NON ADMITTED ASSETS -1,195,360. CHANGE IN PROVISION FOR REINSURANCE -43,000. 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 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 INJURED WORKERS INSURANCE FUND Q 2205880 FAIR VALUE