2017-11-15T08:40:15-06:00 2016-12-31 521446779 JOHNSON LAMBERT LLP 4242 SIX FORKS RD STE 1500 RALEIGH NC 27609 990 2016-01-01 461056754 CHESAPEAKE EMPLOYERS' INSURANCE COMPANY CHES 8722 LOCH RAVEN BOULEVARD TOWSON MD 212862235 FRANCIS LINARDI CHIEF FINANCIAL OFFICER 4104942000 2017-11-14 1 JOHN HUSKINS P01081531 9197196400 2017-11-14 66.77.128.118 2017-11-15 09:39:44 ES P E92EC12878E6ED9F107DFBFC32DE29E76F0C1F5F E92EC12878E6ED9F107DFBFC32DE29E76F0C1F5F 2016 2017-02-10 21:41:12Z THOMAS PHELAN 8722 LOCH RAVEN BOULEVARD TOWSON MD 212862235 1016420595 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 9 248 0 0 0 0 0 234147028 237646694 87346245 107001658 2501 593669 321495774 345242021 397180 750000 0 0 38064330 33523988 0 0 0 197628759 229476107 236090269 263750095 85405505 81491926 2070053091 2210995457 1604778225 1669065290 465274866 541930167 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 4,000 OPEN CLAIMS AT DECEMBER 31, 2016. 0 0 0 0 0 0 0 0 0 1 0 0 1 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 1 248 1 0 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 CHARLES H DANKMEYER JR CHAIRMAN 1.50 0.50 X X 43062 0 3314 JOSEPH M COALE VICE CHAIRMAN 1.50 0.50 X X 44587 0 3434 VINCENT ROCKY GONZALEZ TREASURER 1.50 0.50 X X 44067 0 2965 WAYNE R GIOIOSO SR SECRETARY 1.50 0.50 X X 42070 0 3274 PAUL V GILL DIRECTOR 1.50 0.50 X 33233 0 32203 LEWIS C POWELL DIRECTOR 1.50 0.50 X 28356 0 38714 LEONARD SCHULER DIRECTOR 1.50 0.50 X 37196 0 10461 SUZANNE THOMPSON DIRECTOR 1.50 0.50 X 32957 0 23940 MARIA TILDON DIRECTOR 1.50 0.50 X 40315 0 3114 THOMAS PHELAN PRESIDENT & CEO 30.00 10.00 X 377503 0 39200 DENNIS CARROLL GENERAL COUNSEL (TO APR '16) 30.00 10.00 X 253215 0 35804 PAIGE BECK CHIEF INNOVATION OFFICER (TO MAR '16) 30.00 10.00 X 227521 0 53615 TIMOTHY MICHELS CHIEF OPERATING OFFICER (TO MAR '16) 30.00 10.00 X 212926 0 54648 FRANCIS LINARDI CHIEF FINANCIAL OFFICER 30.00 10.00 X 199197 0 28917 CARMINE D'ALESSANDRO CHIEF LEGAL OFFICER (FROM OCT '16) 30.00 10.00 X 158866 0 25779 PAULETTE LUNDY VICE PRESIDENT 30.00 10.00 X 173392 0 13600 STEPHEN FISHER DIRECTOR OF HEALTH SERVICES 30.00 10.00 X 171856 0 13333 SONG MITCH HE CHIEF INVESTMENT OFFICER 30.00 10.00 X 162377 0 42853 SHARON ROWELL CHIEF ADMINISTRATIVE OFFICER 30.00 10.00 X 161077 0 25779 RIAL SIMONS CHIEF ACTUARY 30.00 10.00 X 156638 0 15809 LISA KRUSKA VICE PRESIDENT 30.00 10.00 X 152249 0 20871 KAMA SCHNEIDER VICE PRESIDENT 30.00 10.00 X 150554 0 26688 WILLIAM SMULYAN MEDICAL CONSULTANT 30.00 10.00 X 220634 0 17222 DONNA WILSON SENIOR VICE PRESIDENT 30.00 10.00 X 177246 0 43276 RONA FINKELSTEIN SENIOR VICE PRESIDENT 30.00 10.00 X 174324 0 43235 JOSEPH CURRAN ASSISTANT VICE PRESIDENT 30.00 10.00 X 163857 0 12520 ROBERT MARSHALL VICE PRESIDENT 30.00 10.00 X 155403 0 25105 3794678 0 659673 74 0 1 0 EXPRESS SCRIPTS INC ONE EXPRESS WAY MS HQ2E04 ST LOUIS MO 63121 MEDICAL/HEALTH SERVICES 4019100 VGM GROUP INC PO BOX 1860 WATERLOO IA 50704 MEDICAL/HEALTH SERVICES 2496863 UNIVERSITY OF MD MEDICAL SYSTEM CORP 11 S PACA ST STE LL BALTIMORE MD 21201 MEDICAL/HEALTH SERVICES 2185338 ASSET ALLOCATION & MANAGEMENT COMPANY LL 30 W MONROE 3RD FLOOR CHICAGO IL 60603 INVESTMENT SERVICES 1165444 MEDSTAR-GEORGETOWN MEDICAL CENTER INC 3800 RESERVOIR RD NW WASHINGTON DC 20007 MEDICAL/HEALTH SERVICES 973105 129 PREMIUMS EARNED 524150 236889427 236889427 INSTALLMENT FEES & NSF CHARGES 900099 757267 757267 237646694 66108741 66108741 712071491 671178574 40892917 40892917 40892917 593669 593669 593669 345242021 238240363 0 107001658 X 750000 3421529 23128870 2060591 3123660 1789338 898952 221690 5113263 31880196 1984559 2904671 1283681 2285282 357805 178902 283603 3305129 818259 LOSSES 166013508 TAXES, LICENSES, FEES 7957107 3989500 263750095 9072984 -1315308 134782047 39964419 79217971 86164314 38025614 28435863 9958264 9589751 1587109522 1871478977 81457059 52550988 168455244 152562316 2070053091 2210995457 17414121 20210910 266530 384918 107300597 111092428 1479796977 1537377034 1604778225 1669065290 X 463274866 539930167 2000000 2000000 465274866 541930167 2070053091 2210995457 X 81491926 -2121862 -2714763 X 0 1 X 1 0 1335400 1335400 14206861 6836319 7370542 22483353 21599544 883809 9589751 SECURITIES LENDING REINVESTED COLLATERAL ASSETS 121459371 INVESTMENT INCOME, DUE AND ACCRUED 12812180 RECEIVABLES FROM AFFILIATE 16090867 RECEIVABLES FOR SECURITIES 752768 FUNDS HELD BY REINSURED COMPANIES 1111130 OTHER ASSETS 336000 152562316 LOSSES & LOSS ADJUSTMENT EXPENSES 1315320000 PAYABLE FOR SECURITIES LENDING 121459371 DIVIDENDS 213956 FUNDS HELD BY COMPANY UNDER REINSURANCE TREATY 308000 BORROWED MONEY & ACCRUED INTEREST 100075707 1537377034 X 335205347 -2121862 -2121862 337327209 7914812 7914812 345242021 255835283 0 255835283 7914812 7914812 263750095 PART X, LINE 2: CHESAPEAKE DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS AS OF DECEMBER 31, 2016. 1 MARYLAND DEPARTMENT OF MENTAL HEALTH AND HYGIENE 201 WEST PRESTON ST BALTIMORE MD 21201 526002033 115 750000 FOR THE PRESCRIPTION DRUG MONITORING PROGRAM AND OTHER ACTIVITIES DESIGNED TO COMBAT OPIOID ABUSE 1 PART I, LINE 2: THE GRANTEE IS REQUIRED TO USE THE GRANT FUNDS FOR ITS OPIOID ABUSE PREVENTION EFFORTS THROUGH THE PRESCRIPTION DRUG MONITORING PROGRAM. THE ORGANIZATION REVIEWS THE GRANTEE'S ANNUAL REPORT OF THE ADVISORY BOARD THAT IS FURNISHED TO THE GOVERNOR AND THE MARYLAND GENERAL ASSEMBLY. X 0 1 0 THOMAS PHELAN PRESIDENT & CEO 354331 0 14000 0 9172 0 39200 0 0 0 416703 0 0 0 DENNIS CARROLL GENERAL COUNSEL (TO APR '16) 205731 0 9759 0 37725 0 6756 0 29048 0 289019 0 0 0 PAIGE BECK CHIEF INNOVATION OFFICER (TO MAR '16 196776 0 7974 0 22771 0 39322 0 14293 0 281136 0 0 0 TIMOTHY MICHELS CHIEF OPERATING OFFICER (TO MAR '16) 196576 0 7974 0 8376 0 40117 0 14531 0 267574 0 0 0 FRANCIS LINARDI CHIEF FINANCIAL OFFICER 184393 0 7390 0 7414 0 15470 0 13447 0 228114 0 0 0 CARMINE D'ALESSANDRO CHIEF LEGAL OFFICER (FROM OCT '16) 149747 0 5850 0 3269 0 11248 0 14531 0 184645 0 0 0 PAULETTE LUNDY VICE PRESIDENT 166592 0 6800 0 0 0 13600 0 0 0 186992 0 0 0 STEPHEN FISHER DIRECTOR OF HEALTH SERVICES 166165 0 5691 0 0 0 13333 0 0 0 185189 0 0 0 SONG MITCH HE CHIEF INVESTMENT OFFICER 156445 0 5932 0 0 0 13133 0 29720 0 205230 0 0 0 SHARON ROWELL CHIEF ADMINISTRATIVE OFFICER 149306 0 5847 0 5924 0 11248 0 14531 0 186856 0 0 0 RIAL SIMONS CHIEF ACTUARY 150507 0 6131 0 0 0 10637 0 5172 0 172447 0 0 0 LISA KRUSKA VICE PRESIDENT 146439 0 5810 0 0 0 10410 0 10461 0 173120 0 0 0 KAMA SCHNEIDER VICE PRESIDENT 144957 0 5597 0 0 0 13785 0 12903 0 177242 0 0 0 WILLIAM SMULYAN MEDICAL CONSULTANT 215280 0 5354 0 0 0 17222 0 0 0 237856 0 0 0 DONNA WILSON SENIOR VICE PRESIDENT 170132 0 7114 0 0 0 14228 0 29048 0 220522 0 0 0 RONA FINKELSTEIN SENIOR VICE PRESIDENT 167230 0 7094 0 0 0 14187 0 29048 0 217559 0 0 0 JOSEPH CURRAN ASSISTANT VICE PRESIDENT 156498 0 5939 0 1420 0 12520 0 0 0 176377 0 0 0 ROBERT MARSHALL VICE PRESIDENT 149312 0 6091 0 0 0 14250 0 10855 0 180508 0 0 0 PART I, LINE 4B TIMOTHY MICHELS SUPPLEMENTAL NON-QUALIFIED PLAN $30,780 PAIGE BECK SUPPLEMENTAL NON-QUALIFIED PLAN $28,460 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 11B 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 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 6,287,464. COMMISSION 25,592,732. FORM 990, PART XI, LINE 9: CHANGE IN NON ADMITTED ASSETS -2,777,763. CHANGE IN PROVISION FOR REINSURANCE 63,000. 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 Q 2462202 FAIR VALUE INJURED WORKERS INSURANCE FUND D 16090867 FAIR VALUE INJURED WORKERS INSURANCE FUND S 11205301 FAIR VALUE