2021-11-12T15:38:49-06:00 2020-12-31 521446779 JOHNSON LAMBERT LLP 4242 SIX FORKS ROAD SUITE 1500 RALEIGH NC 27609 990 2020-01-01 461056754 CHESAPEAKE EMPLOYERS' INSURANCE COMPANY CHES 4104942000 8722 LOCH RAVEN BOULEVARD TOWSON MD 212862235 FRANCIS LINARDI CHIEF FINANCIAL OFFICER 4104942000 2021-11-12 1 FRANCIS LINARDI 999009999 J CALVIN MARKS P01226973 9197196400 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z THOMAS PHELAN 8722 LOCH RAVEN BOULEVARD TOWSON MD 212862235 698225548 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 0 278 0 0 0 0 0 206032392 187940432 137612166 105713808 81001 53274 343725559 293707514 12850 34200 0 0 38083780 39089239 0 0 0 149631369 170468166 187727999 209591605 155997560 84115909 2378021639 2428633683 1465971919 1395638549 912049720 1032995134 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 2,650 OPEN CLAIMS AT DECEMBER 31, 2020. 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 1 278 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 702124 0 48800 KEVIN BINGHAM CHIEF RESULTS OFFICER 30.00 10.00 X 527762 0 62810 PAIGE BECK PRESIDENT 30.00 10.00 X 367406 0 22800 SHARON ROWELL CHIEF ADMINISTRATIVE OFFICER 30.00 10.00 X 296397 0 19164 FRANK LINARDI CHIEF FINANCIAL OFFICER 30.00 10.00 X 262858 0 32961 CARMINE D'ALESSANDRO CHIEF LEGAL OFFICER 30.00 10.00 X 248524 0 30611 SONG MITCH HE CHIEF INVESTMENT OFFICER 30.00 10.00 X 218948 0 48183 STEPHEN FISHER MEDICAL CONSULTANT 30.00 10.00 X 214155 0 16462 LISA KRUSKA VICE PRESIDENT OF CLAIMS 30.00 10.00 X 204074 0 11848 JOAN ADELMAN VICE PRESIDENT OF LEGAL SERVICES 30.00 10.00 X 199820 0 12536 RONA FINKELSTEIN CHIEF COMPLIANCE OFFICER 30.00 10.00 X 184773 0 46471 KAMA SCHNEIDER VICE PRESIDENT OF UNDERWRITING AND SAFETY SERVICES 30.00 10.00 X 181866 0 14799 ANITA SANGITARAO SENIOR PROGRAMMER 30.00 10.00 X 172912 0 19909 SUZANNE THOMPSON BOARD CHAIR 1.50 0.50 X X 44358 0 13675 MARIA TILDON DIRECTOR 1.50 0.50 X 42148 0 3192 FRANKLIN HAJEK DIRECTOR 1.50 0.50 X 41982 0 3430 WAYNE R GIOIOSO SR VICE CHAIR 1.50 0.50 X X 41914 0 3430 MARTIN MADDEN DIRECTOR 1.50 0.50 X 39900 0 0 KETURAH HARLEY DIRECTOR 1.50 0.50 X 39900 0 0 LEONARD SCHULER DIRECTOR (TO NOV '20) 1.50 0.50 X 34536 0 10623 JASON SCHUPP DIRECTOR (FROM MAR '20) 1.50 0.50 X 29314 0 0 VINCENT ROCKY GONZALEZ DIRECTOR (TO MAY '20) 1.50 0.50 X 24102 0 1657 JOHN SCOTT DIRECTOR (FROM JUN '20) 1.50 0.50 X 19183 0 0 LEWIS POWELL DIRECTOR (TO MAR '20) 1.50 0.50 X 12384 0 12878 SPENCER CAVALIER DIRECTOR (FROM NOV '20) 1.50 0.50 X 0 0 0 4151340 0 436239 98 0 1 0 VGM GROUP INC PO BOX 1860 WATERLOO IA 50704 MEDICAL/HEALTH SERVICES 2077555 EXPRESS SCRIPTS INC ONE EXPRESS WAY MS HQ2E04 ST LOUIS MO 63121 MEDICAL/HEALTH SERVICES 1867037 UNIVERSITY OF MD MEDICAL SYSTEM CORP 11 S PACA ST STE LL BALTIMORE MD 21201 MEDICAL/HEALTH SERVICES 1629350 ADVANCED HOME SUPPORT INC 15800 CRABBS BRANCH WAY STE 205 ROCKVILLE MD 20855 MEDICAL/HEALTH SERVICES 1005561 WELLINGTON MANAGEMENT COMPANY LLP PO BOX 412416 BOSTON MA 02241 INVESTMENT SERVICES 946340 110 PREMIUMS EARNED 900099 187602726 187602726 INSTALLMENT FEES & NSF CHARGES 900099 337706 337706 187940432 67987352 67987352 442244490 404518034 37726456 37726456 37726456 53274 53274 53274 293707514 187940432 0 105767082 X 34200 3504619 27619500 2312023 3559108 2093989 1081743 366713 5802273 29908713 2222161 2978428 1506512 2547607 164217 82109 952682 5475831 697786 LOSSES 92579240 DIVIDENDS 15888010 TAXES, LICENSES, FEES 7415208 798933 209591605 969024 10282005 68673192 87152217 64004322 58781580 41984857 33458014 8597479 8526843 2061994062 2140543170 57629740 81736250 116153820 41611618 2378021639 2428633683 21974504 36001872 93032307 77341451 1350965108 1282295226 1465971919 1395638549 X 912049720 1032995134 912049720 1032995134 2378021639 2428633683 X 84115909 41668569 -4839064 X 0 1 X 1 0 1335400 1335400 14206861 7784803 6422058 26442596 25673211 769385 8526843 LOSSES & LOSS ADJUSTMENT EXPENSES 1112687000 BORROWED MONEY & ACCRUED INTEREST 140036169 DIVIDENDS PAYABLE 29213057 FUNDS HELD BY COMPANY UNDER REINSURANCE TREATY 271000 PROVISION FOR REINSURANCE 88000 1282295226 X 325213487 41668569 41668569 283544918 10162596 10162596 293707514 201502182 2073173 2073173 199429009 10162596 10162596 209591605 PART X, LINE 2: CHESAPEAKE DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS AS OF DECEMBER 31, 2020. PART XII, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT 2,073,173. 1 COLORECTAL CANCER ALLIANCE 1025 VERMONT AVE NW WASHINGTON DC 20005 860947831 501(C)(3) 10000 GENERAL SUPPORT MARYLAND FOOD BANK 2200 HALETHORPE FARMS RD BALTIMORE MD 21227 521135690 501(C)(3) 10000 GENERAL SUPPORT FRANCISCAN CENTER INC 101 W 23RD ST BALTIMORE MD 21218 521164260 501(C)(3) 7200 GENERAL SUPPORT BALTIMORE URBAN LEADERSHIP FOUNDATION INC 219 N CHESTER ST BALTIMORE MD 21231 521708248 501(C)(3) 7000 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 562322 0 104756 0 35046 0 48800 0 0 0 750924 0 0 0 KEVIN BINGHAM CHIEF RESULTS OFFICER 386604 0 128908 0 12250 0 22800 0 40010 0 590572 0 0 0 PAIGE BECK PRESIDENT 309722 0 21149 0 36535 0 22800 0 0 0 390206 0 0 0 SHARON ROWELL CHIEF ADMINISTRATIVE OFFICER 229491 0 17728 0 49178 0 19164 0 0 0 315561 0 0 0 FRANK LINARDI CHIEF FINANCIAL OFFICER 229981 0 18996 0 13881 0 17464 0 15497 0 295819 0 0 0 CARMINE D'ALESSANDRO CHIEF LEGAL OFFICER 210639 0 17853 0 20032 0 15130 0 15481 0 279135 0 0 0 SONG MITCH HE CHIEF INVESTMENT OFFICER 208392 0 10556 0 0 0 17262 0 30921 0 267131 0 0 0 STEPHEN FISHER MEDICAL CONSULTANT 204251 0 9904 0 0 0 16462 0 0 0 230617 0 0 0 LISA KRUSKA VICE PRESIDENT OF CLAIMS 150149 0 10412 0 43513 0 10803 0 1045 0 215922 0 0 0 JOAN ADELMAN VICE PRESIDENT OF LEGAL SERVICES 165900 0 7582 0 26338 0 9708 0 2828 0 212356 0 0 0 RONA FINKELSTEIN CHIEF COMPLIANCE OFFICER 175580 0 9193 0 0 0 14759 0 31712 0 231244 0 0 0 KAMA SCHNEIDER VICE PRESIDENT OF UNDERWRITING AND S 172854 0 9012 0 0 0 13828 0 971 0 196665 0 0 0 ANITA SANGITARAO SENIOR PROGRAMMER 88513 0 5274 0 79125 0 6747 0 13162 0 192821 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 RIGHTPHASED IN FROM 2020 THROUGH 2022 TO APPOINT SEVEN OF THE ORGANIZATION'S NINE DIRECTORS. THE POLICYHOLDERS APPOINTED TWO DIRECTORS TO THE ORGANIZATION'S BOARD EFFECTIVE JUNE 1, 2020. THIS WAS THE FIRST TIME THE POLICYHOLDERS APPOINTED ANY DIRECTORS TO THE ORGANIZATION'S BOARD. THE POLICYHOLDERS EXERCISING THEIR NEW RIGHT TO APPOINT DIRECTORS MAY BE TREATED FOR U.S. FEDERAL INCOME TAX PURPOSES AS A DEEMED EXCHANGE BY THE POLICYHOLDERS OF THEIR INTERESTS IN THE ORGANIZATION FOR NEW INTERESTS IN THE ORGANIZATION THAT PROVIDE THE SAME ECONOMIC RIGHTS ALONG WITH INCREASED VOTING RIGHTS IN A TRANSACTION THAT IS DESCRIBED IN SECTION 368(A)(1)(E) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. IN THAT CASE, THE STATEMENT REQUIRED BY TREASURY REGULATION SECTION 1.368-3(A) IS INCLUDED BELOW. ALTERNATIVELY, 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. THERE IS A PENDING PRIVATE LETTER RULING REQUEST THAT WAS SUBMITTED BY THE ORGANIZATION ON OCTOBER 14, 2021 (CONTROL NUMBER PLR-121522-21) THAT RELATES TO THIS MATTER. STATEMENT PURSUANT TO 1.368-3(A) BY CHESAPEAKE EMPLOYERS' INSURANCE COMPANY (EIN: 46-1056754), A CORPORATION A PARTY TO A REORGANIZATION THE FOLLOWING INFORMATION IS PROVIDED PURSUANT TO TREASURY REGULATION SECTION 1.368-3(A): 1) THE NAMES AND EMPLOYER IDENTIFICATION NUMBERS OF ALL THE PARTIES: CHESAPEAKE EMPLOYERS' INSURANCE COMPANY (EIN: 46-1056754). 2) THE DATE OF THE REORGANIZATION: JUNE 1, 2020. 3) THE VALUE AND BASIS OF THE ASSETS, STOCK, OR SECURITIES OF THE TARGET CORPORATION TRANSFERRED IN THE TRANSACTION, DETERMINED IMMEDIATELY BEFORE THE TRANSFER: THE VALUE AND BASIS, DETERMINED IMMEDIATELY BEFORE THE EXCHANGE, OF THE ASSETS, STOCK, OR SECURITIES OF THE TARGET CORPORATION TRANSFERRED IN THE TRANSACTION DO NOT APPLY IN THIS INSTANCE BECAUSE THIS REORGANIZATION WAS A RECAPITALIZATION (WITHIN THE MEANING OF SECTION 368(A)(1)(E) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED). 4) THE DATE AND CONTROL NUMBER OF ANY PRIVATE LETTER RULING(S) ISSUED BY THE INTERNAL REVENUE SERVICE IN CONNECTION WITH THIS REORGANIZATION: THERE IS A PENDING PRIVATE LETTER RULING REQUEST THAT WAS SUBMITTED BY THE TAXPAYER ON OCTOBER 14, 2021 (CONTROL NUMBER PLR-121522-21) THAT RELATES TO THIS REORGANIZATION. 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 29,908,713. FORM 990, PART XI, LINE 9: CHANGE IN NON ADMITTED ASSETS -3,571,891. BAD DEBT -2,073,173. CHANGE IN PROVISION FOR REINSURANCE 806,000. 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 12019089 FAIR VALUE INJURED WORKERS INSURANCE FUND Q 4846612 FAIR VALUE INJURED WORKERS INSURANCE FUND D 1326800 FAIR VALUE