Form F-10 Quarterly Survey of the Finances of Public Employee Reti

OMB No. 0607-0143: Approval Expires 12/31/2008
U.S. DEPARTMENT OF COMMERCE

F-10

FORM
(2-27-2006)

Economics and Statistics Administration
U.S. CENSUS BUREAU

QUARTERLY SURVEY OF THE FINANCES OF
PUBLIC EMPLOYEE RETIREMENT SYSTEMS
In correspondence pertaining to this report, please refer to the Unit Identification Number above your address

RETURN TO
U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001
Date covered by this report (Please
provide data for assets held as of the
last day of calendar quarter ending):
Month

Day

Year

RETURN BY
(Please correct any error in name, address, and ZIP Code)

INTERNET RESPONSE: You may respond
to this survey using the internet at:
http://harvester.census.gov/sgf/f10/
Your User ID to access the Internet form is.:
DATA SUPPLIED BY
Title

Name

Telephone number

(

Extension

)

Fax number

(

)
Government Website

E-mail address

FROM THE DIRECTOR
U.S. CENSUS BUREAU
The U.S. Census Bureau is conducting the Quarterly Survey of Public Employee Retirement Systems. Please
complete this questionnaire and return it in the enclosed addressed envelope within 30 days, if possible. We
will use your information to produce the Quarterly Summary of Public Employee Retirement System reports,
which will provide current statistics on system-held assets and decisions made by financial managers in this
key sector of institutional investment. The data requested are not confidential because they are public record
information.
We prefer that you use actual amounts in completing this survey, but reasonable estimates are acceptable if
actual data are not available. We will not publish any amounts relating to particular systems. The data will be
used only for statistical purposes to assemble national totals.
We estimate that it will take from 1/2 hour to 2 hours to complete this survey, with 45 minutes being the
average time. This includes time to read the instructions, assemble material, organize and review the
information, and maintain and report the information. Send comments regarding the burden estimate or any
4600 Silver
other aspect of this collection of information to: Paperwork Project 0607-0143, U.S. Census Bureau, 4700
Hill Road, Stop
Washington,
DC 20233-1500.
Room1500,
3K138,
Washington,
DC 20233. You may e-mail comments to Paperwork@census.gov; use
"Paperwork Project 0607-0143" as the subject.
The U.S. Office of Management and Budget (OMB) approved this survey and gave it OMB approval number
0607-0143. Displaying this number shows that the Census Bureau is authorized to conduct this survey.
If you have any questions, please call the Census Bureau’s Governments Division on 1-888-529-1963. Thank you
for your cooperation in this voluntary survey. The Census Bureau appreciates your help.
Sincerely,

Steve
H. Louis
Murdock
Charles
Kincannon
Enclosures
BASIC INSTRUCTIONS AND SUGGESTIONS
Before filling out this form, carefully read all definitions and instructions.
Note especially:
1. In order to obtain needed detail information this form
has been revised to request market value for corporate
bonds, corporate stocks, and foreign and international
securities.
2. Please report figures for the last date of the calendar
quarter named in the space provided above.

USCENSUSBUREAU

3. Report assets relating to all accounts and reserves of
your system, INCLUDING amounts for retirement,
disability, survivors’, and other benefits.
4. PLEASE COMPLETE ALL ITEMS ON THE FORM. If some
items do not apply to your system, do not merely leave
them blank, but enter "None" or a dash in the reporting
space provided.
PLEASE COMPLETE FORM ON REVERSE

Do not delay reporting to await final figures, if substantially accurate figures can be supplied on a preliminary basis.

Part I

FINANCES
Item

A. RECEIPTS DURING QUARTER – Exclude amounts received from sales of
investments, and from repayment of loans made to members.

Amount (Omit cents)
X01/X02

1. Employee contributions – Amounts contributed by members or withheld
from their salaries for financing of benefits
X04/X06

2. Government contributions – Amounts contributed by administrating state
and local governments for financial support of your system, including any
taxes credited directly to your system
X05

3. Other government contributions – Any contributions from another government,
not previously reported in A1 or A2. Include state aid, shared taxes and any other
amounts received from governments on behalf of their employees.
4. Earnings on investments – Interest and dividends are reported at 4a and 4b.
The net of gains and losses on the sale of investments is reported at 4c.
a. Interest

Z71

Z72

b. Dividends
Z96/Z91

- Include both realized + unrealized gains (losses)
c. Net gain
gain or
orloss
losson
oninvestments
investments
B. PAYMENTS DURING QUARTER – Exclude amounts paid out for purchase of
investments and for loans made to members.

X11

1. Benefits paid – Retirement, disability, survivors’, and other benefits
X12

2. Withdrawals – Amounts paid to members or former members or their survivors,
representing return of contributions made by members during the period of their
employment.
Z93

3. Administration – Include investment fees

Part II

CASH AND INVESTMENTS AT END OF QUARTER AT MARKET VALUE
Item

A. CASH AND SHORT-TERM INVESTMENTS – Include cash on hand, demand
deposits, time or savings deposits, securities in repurchase agreements,
commercial and finance company paper and bankers acceptances, and
miscellaneous money market funds.

Amount (Omit cents)
X21

B. FEDERAL GOVERNMENT SECURITIES – Obligations of the U.S. Treasury
(including short-term notes) and Federal Financing Bank, bonds and
mortgage-backed securities (where applicable) issued by CCC, Export-Import Bank,
FHA, GNMA, Postal Service, and TVA.

X30

C. CORPORATE BONDS – Corporate bonds including debentures, convertible bonds, and
railroad equipment certificates plus Federally sponsored agency securities including
bonds and mortgage backed securities (where applicable) issued by FHLB, FHLMC,
FNMA, Farm credit banks and SLMA.

Z77

D. CORPORATE STOCKS – Include common and preferred stocks, warrants, and
investment company shares.

Z78

Z70

E. FOREIGN AND INTERNATIONAL SECURITIES
X42

F. MORTGAGES – Exclude mortgage-backed securities, report at B or C; also exclude
real property that is owned, report at H.
G. OTHER SECURITIES

X35

1. Securities of state and local governments
2. Other – Include funds held in trust by other agencies, shares held in mutual funds,
conditional sales contracts, direct loans, loans to members, etc. – Specify
H. OTHER INVESTMENTS – Include directly held real property, venture capital,
partnerships, real estate investment trusts, leveraged buyouts, etc., – Specify

Z83/Z84

Z82

Z81

I. TOTAL HOLDINGS AND INVESTMENTS (AT MARKET VALUE)
(Sum of items A through H, above)
SUPPLEMENTARY INFORMATION – Please use this space to explain any items that were
difficult to classify, or to provide additional information concerning any of the entities on the form.

FORM F-10 (2-27-2006)