2022-11-08T18:35:34-06:00 2021-12-31 521446779 JOHNSON LAMBERT LLP 4242 SIX FORKS ROAD SUITE 1500 RALEIGH NC 27609 990 2021-01-01 461056754 CHESAPEAKE EMPLOYERS' INSURANCE COMPANY CHES 4104942000 8722 LOCH RAVEN BOULEVARD TOWSON MD 212862235 FRANCIS LINARDI CFO 4104942000 2022-11-08 1 FRANCIS LINARDI 999009999 J CALVIN MARKS P01226973 9197196400 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z THOMAS PHELAN 8722 LOCH RAVEN BOULEVARD TOWSON MD 212862235 1883950808 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 0 308 0 0 0 0 0 187940432 169321067 105713808 167646106 53274 103572 293707514 337070745 34200 302325 0 0 39089239 40939190 0 0 0 170468166 168464787 209591605 209706302 84115909 127364443 2428633683 2512331700 1395638549 1374799656 1032995134 1137532044 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 21,000 IN-FORCE POLICIES AND WAS MANAGING MORE THAN 2,960 OPEN CLAIMS AT DECEMBER 31, 2021. 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 1644 0 1 308 1 0 0 0 0 0 0 0 0 X 9 0 0 0 0 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 CHIEF EXECUTIVE OFFICER 30.00 10.00 X 753067 0 22800 KEVIN BINGHAM CHIEF RESULTS OFFICER 30.00 10.00 X 567760 0 65101 PAIGE BECK PRESIDENT 30.00 10.00 X 386061 0 22800 FRANK LINARDI CHIEF FINANCIAL OFFICER 30.00 10.00 X 285246 0 30781 SHARON ROWELL CHIEF ADMINISTRATIVE OFFICER 30.00 10.00 X 280768 0 19492 CARMINE D'ALESSANDRO CHIEF LEGAL OFFICER 30.00 10.00 X 264990 0 33493 SONG MITCH HE CHIEF INVESTMENT OFFICER 30.00 10.00 X 226308 0 52622 STEPHEN FISHER MEDICAL CONSULTANT 30.00 10.00 X 218683 0 16762 RONA FINKELSTEIN CHIEF COMPLIANCE OFFICER 30.00 10.00 X 167593 0 47326 SCOTT TRICKETT CHIEF INFORMATION SECURITY OFFICER 30.00 10.00 X 167858 0 29187 JOAN ADELMAN VICE PRESIDENT OF LEGAL SVCS 30.00 10.00 X 183133 0 13906 ALAINA LIBERTO CHIEF INFORMATION OFFICER 30.00 10.00 X 161777 0 28141 SUZANNE THOMPSON BOARD CHAIR 1.50 0.50 X X 46489 0 0 FRANKLIN HAJEK DIRECTOR 1.50 0.50 X 44401 0 601 MARIA TILDON DIRECTOR 1.50 0.50 X 44434 0 448 SPENCER CAVALIER DIRECTOR 1.50 0.50 X 43127 0 0 KETURAH HARLEY DIRECTOR 1.50 0.50 X 41639 0 0 MARTIN MADDEN DIRECTOR 1.50 0.50 X 41439 0 0 JASON SCHUPP DIRECTOR 1.50 0.50 X 41439 0 0 JOHN SCOTT JR VICE CHAIR 1.50 0.50 X X 41439 0 0 WAYNE R GIOIOSO SR DIRECTOR (TO JUN '21) 1.50 0.50 X 24767 0 1841 THEODORE ALEXANDER III DIRECTOR (FROM JUN '21) 1.50 0.50 X 20721 0 0 4053139 0 385301 98 0 1 0 UNIV OF MD MEDICAL SYSTEM CORP 11 S PACA ST STE LL BALTIMORE MD 21201 MEDICAL/HEALTH SERVICES 2351422 VGM GROUP INC PO BOX 1860 WATERLOO IA 50704 MEDICAL/HEALTH SERVICES 1824086 JOHNS HOPKINS BAYVIEW MEDICAL CENTER 4940 EASTERN AVE BALTIMORE MD 21224 MEDICAL/HEALTH SERVICES 1797718 BROWN CAPITAL MANAGEMENT LLC 1201 NORTH CALVERT ST BALTIMORE MD 21202 INVESTMENT SERVICES 1293561 EXPRESS SCRIPTS INC ONE EXPRESS WAY MS HQ2E04 ST LOUIS MO 63121 MEDICAL/HEALTH SERVICES 1257967 150 PREMIUMS EARNED 900099 168935969 168935969 INSTALLMENT FEES & NSF CHARGES 900099 385098 385098 169321067 67008296 67008296 1647517873 1546880063 100637810 100637810 100637810 103572 103572 103572 337070745 169321067 0 167749678 X 302325 3404074 28571158 2241371 4492910 2229677 907626 404620 6549116 32558787 2412130 3401691 1685041 2782595 164370 82185 402385 6578323 860776 LOSSES 87972585 DIVIDENDS 15924910 TAXES, LICENSES, FEES 5208229 569418 209706302 9551587 17156257 87882635 68610724 58781580 54308368 43453233 34885907 8526843 8567326 2140543170 2220076387 81736250 107245467 41611618 36367171 2428633683 2512331700 36001872 27707515 77341451 79969853 1282295226 1267122288 1395638549 1374799656 X 1032995134 1137532044 1032995134 1137532044 2428633683 2512331700 X 127364443 -23455252 627719 X 0 1 X 1 0 1335400 1335400 14206861 8021925 6184936 27910972 26863982 1046990 8567326 LOSSES & LOSS ADJUSTMENT EXPENSES 1092116000 BORROWED MONEY & ACCRUED INTEREST 140034218 DIVIDENDS PAYABLE 34221070 PROVISION FOR REINSURANCE 539000 FUNDS HELD BY COMPANY UNDER REINSURANCE TREATY 212000 1267122288 X 303224819 -23455252 -23455252 326680071 10390674 10390674 337070745 200990903 1675275 1675275 199315628 10390674 10390674 209706302 PART X, LINE 2: CHESAPEAKE DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS AS OF DECEMBER 31, 2021. PART XII, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT 1,675,275. 1 KIDS CHANCE OF MARYLAND INC PO BOX 20262 BALTIMORE MD 21284 522037902 501(C)(3) 11825 0 GENERAL SUPPORT SPECIAL OLYMPICS 3701 COMMERCE DR STE 103 BALTIMORE MD 21227 237089144 501(C)(3) 7050 0 GENERAL SUPPORT MY SISTERS PLACE 320 CATHEDRAL ST BALTIMORE MD 21201 520591538 501(C)(3) 5550 0 GENERAL SUPPORT MARYLAND FOOD BANK 2200 HALETHORPE FARMS RD BALTIMORE MD 21227 521135690 501(C)(3) 5500 0 GENERAL SUPPORT 4 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 0 0 THOMAS PHELAN CHIEF EXECUTIVE OFFICER 570933 0 176583 0 5551 0 22800 0 0 0 775867 0 0 0 KEVIN BINGHAM CHIEF RESULTS OFFICER 390235 0 165000 0 12525 0 22800 0 42301 0 632861 0 0 0 PAIGE BECK PRESIDENT 337307 0 29212 0 19542 0 22800 0 0 0 408861 0 0 0 FRANK LINARDI CHIEF FINANCIAL OFFICER 239848 0 25235 0 20163 0 13553 0 17228 0 316027 0 0 0 SHARON ROWELL CHIEF ADMINISTRATIVE OFFICER 242654 0 25074 0 13040 0 19492 0 0 0 300260 0 0 0 CARMINE D'ALESSANDRO CHIEF LEGAL OFFICER 224256 0 24338 0 16396 0 16303 0 17190 0 298483 0 0 0 SONG MITCH HE CHIEF INVESTMENT OFFICER 214520 0 11788 0 0 0 17746 0 34876 0 278930 0 0 0 STEPHEN FISHER MEDICAL CONSULTANT 207395 0 11288 0 0 0 16762 0 0 0 235445 0 0 0 RONA FINKELSTEIN CHIEF COMPLIANCE OFFICER 153750 0 10224 0 3619 0 12928 0 34398 0 214919 0 0 0 SCOTT TRICKETT CHIEF INFORMATION SECURITY OFFICER 158781 0 8827 0 250 0 11486 0 17701 0 197045 0 0 0 JOAN ADELMAN VICE PRESIDENT OF LEGAL SVCS 173828 0 9305 0 0 0 13906 0 0 0 197039 0 0 0 ALAINA LIBERTO CHIEF INFORMATION OFFICER 152920 0 8827 0 30 0 11618 0 16523 0 189918 0 0 0 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 SINCE THE ORGANIZATION'S FORMATION, THE GOVERNOR OF MARYLAND HAS APPOINTED THE BOARD OF DIRECTORS WITH THE ADVICE AND CONSENT OF THE STATE SENATE. UNDER LEGISLATION ADOPTED BY THE STATE OF MARYLAND IN 2015, THE ORGANIZATION'S POLICYHOLDERS WERE GRANTED THE RIGHT, PHASED IN FROM 2020 THROUGH 2022, TO APPOINT SEVEN OF THE ORGANIZATION'S NINE DIRECTORS. AS OF DECEMBER 31, 2021, FOUR OF THE ORGANIZATION'S NINE BOARD MEMBERS HAD BEEN ELECTED BY POLICYHOLDERS. THE POLICYHOLDERS EXERCISING THEIR NEW RIGHT TO APPOINT DIRECTORS MAY NOT RESULT IN ANY EXCHANGE BY THE POLICYHOLDERS FOR U.S. FEDERAL INCOME TAX PURPOSES. THE CONSEQUENCES SHOULD BE THE SAME UNDER EITHER ALTERNATIVE: NO GAIN OR LOSS WILL BE RECOGNIZED BY THE ORGANIZATION OR ITS POLICYHOLDERS AS A RESULT OF THE POLICYHOLDERS EXERCISING THEIR NEW RIGHT TO APPOINT DIRECTORS. ON APRIL 15, 2022, THE IRS ISSUED PRIVATE LETTER RULING("PLR") XXX-XX-XXXX (CONTROL NUMBER PLR 121522-21) STATING THAT THE ORGANIZATION'S STATUS CHANGE WILL NOT BE TREATED AS A SALE OR EXCHANGE, AND ACCORDINGLY, NO GAIN OR LOSS WILL BE REALIZED UNDER SECTION 1001 AS A RESULT OF THE STATUS CHANGE. FORM 990, PART VI, SECTION A, LINE 7B A DIRECTOR APPOINTED BY THE GOVERNOR OF MARYLAND MAY BE REMOVED BY THE GOVERNOR FOR INCOMPETENCE OR MISCONDUCT. A DIRECTOR ELECTED BY MEMBERS MAY BE REMOVED BY THE MEMBERS AT ANY TIME, FOR ANY REASON, BY THE AFFIRMATIVE VOTE OF A MAJORITY OF ALL OF THE VOTES ENTITLED TO BE CAST GENERALLY IN THE ELECTION OF DIRECTORS. THE MARYLAND INSURANCE COMMISSIONER MAY REMOVE A DIRECTOR ELECTED BY THE MEMBERS FOR INCOMPETENCE, MISCONDUCT, OR MALFEASANCE AFTER NOTICE AND AN OPPORTUNITY FOR A HEARING AS REQUIRED PURSUANT TO THE INSURANCE CODE. 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 32,558,787. FORM 990, PART XI, LINE 9: CHANGE IN NON ADMITTED ASSETS 2,753,994. BAD DEBT -1,675,275. CHANGE IN PROVISION FOR REINSURANCE -451,000. INJURED WORKERS INSURANCE FUND 8722 LOCH RAVEN BOULEVARD TOWSON MD 212862235 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 11158054 FAIR VALUE INJURED WORKERS INSURANCE FUND Q 2792213 FAIR VALUE INJURED WORKERS INSURANCE FUND D 1076107 FAIR VALUE