Various Economic Area Pretesting Activities

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

2009 Annual Survey of Locally Administered
Public-Employee Retirement Systems

FORM

F-11 (2009)
(10-30-2009)

OMB No. 0607-0585: Approval Expires 06/30/2011
In correspondence pertaining to this report, refer to the ID printed above your address.

RETURN TO
US Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001

If you have any questions
call 1-888-529-1963
weekdays, 8:00 a.m. to
5:30 p.m. EST.

Questions can also be
e-mailed to
govs.retire@census.gov

Correct any errors in name, address, or ZIP Code.

INTERNET RESPONSE
You may respond to this survey via the Internet at the following Web address: http://harvester.census.gov/sgfnet
You will only need your User ID to access the Internet form. Your User ID is the first 14 digits of the 18 digit ID
located on the top line of the address section above.

IMPORTANT REQUEST
If you are including data for any retirement system(s) administered in addition to the system identified in
the address box above, list retirement system(s) in the space provided below.
Additional systems included in these data:

GENERAL INSTRUCTIONS
Before filling out this form, carefully read each part and all related definitions and instructions.
Note especially:
1. Report for Defined Benefit plans only. Do not include Defined Contribution or Healthcare plans in your data.
2. Report corporate stocks and bonds at market value, and adhere to Governmental
Accounting Standards Board (GASB) guidelines when reporting gains and losses on investments.
3. Report figures relating to all accounts and reserves of your system, including amounts for retirement,
disability, survivors, and other benefits, as well as any amounts for administration of the system.
Report in whole dollars. Exclude transfers between reserves of the system, and also any investment
transactions relating to loans to system members.
4. Do not delay reporting to await finally audited figures, if substantially accurate figures can be supplied on a
preliminary basis.
5. Use a black or blue ball point pen.
RESPONDENT INFORMATION:
Name of person completing report - Please print

Area Code

Extension

Telephone Number

-

Title of person completing report - Please print

E-mail Address - Please print

-

Please continue on the next page
17119017

§2,{2¤

Page 2

Part 1

PLAN INFORMATION FOR DEFINED BENEFIT PLANS

A. Are new employees covered under this pension plan?

Yes

No

B. In addition to the defined benefit plan reported here, does your system
offer a defined contribution plan?

Yes

No

C. In addition to the defined benefit plan reported here, does your system
offer a postemployment healthcare plan?

Yes

No

D. Fiscal Year Ending Date
Mark (X) in the appropriate box below to indicate the ending date of your system’s fiscal year.
Report figures for your system’s fiscal year that ended between July 1, 2008 and June 30, 2009.
Report for this fiscal year even though a more recent one may be available.
2008

Part 2

2009

July

October

January

April

August

November

February

May

September

December

March

June

MEMBERSHIP AND BENEFITS FOR DEFINED BENEFIT PLANS

Report the figures requested below, as of the last month of your fiscal year reported in Part 1,
or the month nearest to that permitted by your records. If detailed figures are not available for an item,
enter an estimate and mark it with an asterisk (*).

A.

MEMBERS OF YOUR RETIREMENT SYSTEM Exclude beneficiaries.
1.

2.

B.

ACTIVE MEMBERS - Current contributors in
contributory systems, or employees in
non-contributory systems.
INACTIVE MEMBERS - Former employees and
employees on military or other extended leave without
pay having retained retirement credits, but
not currently receiving retirement benefit payments.

Z01

Z02

Number
of
Payees
(a)

BENEFICIARIES RECEIVING PERIODIC BENEFIT
PAYMENTS DURING MONTH - Provide estimates if
detailed data are not available.
1.
2.

3.

C.

Number
of
Participants
(a)

Former active members of system, retired on
account of age or service

Z03

Z08

Former active members of system, retired on
account of disability

Z04

Z09

Survivors of deceased former active members

Z05

Z10

2.

Withdrawals and other one-time payments
(other than loans) made to present or
former members of system
Lump-sum (nonrecurrent) payments made to
survivors of deceased former active members

$

.00

$

.00

$

.00

Number
of
Payees
(a)

RECIPIENTS OF LUMP-SUM PAYMENTS
DURING MONTH REPORTED
1.

Amount paid
during month
Omit cents
(b)

Amount paid
during month
Omit cents
(b)

Z06

Z11

Z07

Z12

$

.00

$

.00

Please continue on the next page
F-11 (10-30-2009)

17119025

§2,{:¤

Page 3

Part 3

RECEIPTS/PAYMENTS FOR DEFINED BENEFIT PLANS

A. RECEIPTS DURING FISCAL YEAR - Report receipts during the fiscal year indicated in Part 1.
Exclude amounts received from repayment of loans made to members.
Employee Contributions
1. EMPLOYEE CONTRIBUTIONS Total amounts contributed by all member employees or withheld from
their salaries for financing benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$

.00

X01

2. EMPLOYER (GOVERNMENT) CONTRIBUTIONS
a. From parent local governments - Employer contributions from your
government for financing of benefits and parent government
contributions or appropriations for administration or other
support of the system. Include any local taxes credited directly
to your system. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

X04

b. From other governments - State aid or shared taxes received
by the system from the state governments either directly or
through the parent local government and amounts received from
other local governments on behalf of their employees. . . . . . . . . . . . .

X05

Government Contributions
$

.00

$

.00
Investment Earnings
and Other Receipts

3. EARNINGS ON INVESTMENTS - Interest, dividends, rents, and other
earnings on investments. Exclude any recorded profits or recorded
losses on investment transactions and report in Section B below.
a. Interest Earnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z71

b. Dividend Earnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z72

c. Other Investment Earnings
Specify. . . . . . . . . . . . . . . . . .

Z73

d. Total Earnings on Investments - Sum of items 3a through 3c. . . . . .

X08

4. OTHER RECEIPTS Private gifts or donations, and
the like. Specify. . . . . . . . . . . . .

$

.00

$

.00

$

.00

$

.00

$

.00

Z95

Net Gains (Losses)
B. NET GAINS/LOSSES ON INVESTMENTS IN MARKET/FAIR VALUE Include both realized and unrealized gains (losses). . . . . . . . . . . . . . . . . . .

Z96
Z91

$

.00

C. PAYMENTS DURING FISCAL YEAR - Exclude amounts paid out for
purchase of investments and for loans made to members.
Payments
1. BENEFIT PAYMENTS - Report annual amounts.
a. Retirement Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z13

b. Disability Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z14

c. Survivor Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z15

d. Other Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z16

e. Total Benefit Payments - Sum of items 1a through 1d. . . . . . . . . . . .

X11

2. WITHDRAWALS - Amounts paid to employees, former employees, or their
survivors, representing return of contributions made by employees during the
period of their employment, and any interest on such amounts. . . . . . . . . . . . . .

X12

3. ADMINISTRATIVE EXPENSES - Include investment fees. . . . . . . . . . . .

Z93

4. OTHER PAYMENTS - Specify. . . .

Z90

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

Please continue on the next page
F-11 (10-30-2009)

17119033

§2,{B¤

Page 4

Part 4
A.

1.

CASH ON HAND AND DEMAND DEPOSITS . . . . . . . . . . . . . . . . . . . Z88

2.

TIME OR SAVINGS DEPOSITS - Include certificates of deposit. . . . . . Z87

3.

ALL OTHER SHORT-TERM INVESTMENTS - Include securities in
repurchase agreements, commercial and finance company
paper and bankers acceptances, and miscellaneous
money market funds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z68
TOTAL CASH AND SHORT-TERM INVESTMENTS Sum of items A1 through A3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.

3.

FEDERAL TREASURY SECURITIES - Obligations of the US Treasury
(including short-term notes) and Federal Financing Bank. . . . . . . . . . . .

$

.00

$

.00

$

.00

$

.00

X21

Federal Government Securities

FEDERAL GOVERNMENT SECURITIES
1.

C.

Cash and
Short-term Investments

TOTAL CASH AND SHORT-TERM INVESTMENTS

4.

B.

HOLDINGS AND INVESTMENTS FOR
DEFINED BENEFIT PLANS

$

.00

$

.00

$

.00

Z89

FEDERAL AGENCY SECURITIES - Bonds and mortgage-backed
securities (where applicable) issued by CCC, Export-Import Bank,
FHA, GNMA, Postal Service, and TVA.
Report directly held mortgages in Section E below. . . . . . . . . . . . . . . . X33
TOTAL FEDERAL GOVERNMENT SECURITIES Sum of items B1 and B2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X30

CORPORATE BONDS
1.

Corporate Bonds

FEDERALLY-SPONSORED AGENCIES - Bonds and
mortgage-backed securities (where applicable) issued by
FHLB, FHLMC, FNMA, Farm credit banks, and SLMA. . . . . . . . . . . . . . Z62

$

.00

2.

CORPORATE BONDS, OTHER - Include debentures, convertible
bonds, and railroad equipment certificates. . . . . . . . . . . . . . . . . . . . . . Z63

$

.00

3.

TOTAL CORPORATE BONDS - Sum of items C1 and C2. . . . . . . . . . . Z77

$

.00
Corporate Stocks

D.

CORPORATE STOCKS Include common and preferred stocks and warrants. . . . . . . . . . . . . . . . . .

$

.00

Z78

Mortgages Held Directly
E.

F.

MORTGAGES HELD DIRECTLY - Exclude mortgage-backed securities,
to be reported at B2, C1, or C2; also exclude directly held real property
to be reported at item G1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X42
OTHER SECURITIES
1. INVESTMENTS HELD IN TRUST BY OTHER AGENCIES Include funds administered by private agencies, guaranteed
investment accounts, and your share of funds in
governmental investment accounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . Z84
2.

STATE AND LOCAL GOVERNMENT SECURITIES. . . . . . . . . . . . . . . X35

3.

FOREIGN AND INTERNATIONAL SECURITIES - Include
corporate equities and corporate stocks. . . . . . . . . . . . . . . . . . . . . . . . Z70

4.

OTHER SECURITIES - Include shares held in mutual funds, conditional
sales contracts, direct loans,
loans to members, etc.
Specify. . . . . . . . . . . . . . . . .

5.
G.

$

Other Securities
$

.00

$

.00

$

.00

$

.00

$

.00

Z83

TOTAL OTHER SECURITIES - Sum of items F1 through F4. . . . . . . . . X44

Other Investments

OTHER INVESTMENTS
1.
2.

3.

.00

REAL PROPERTY - Report only directly held property; report property held
in investment trusts and in pooled or partnership agreements at G2. . . . . . . . .

X46

OTHER INVESTMENTS - Include venture capital, partnerships,
real estate investment trusts,
and leveraged buyouts.
Specify. . . . . . . . . . . . . . . .

X47

TOTAL OTHER INVESTMENTS - Sum of items G1 and G2. . . . . . . . . Z82

$

.00

$

.00

$

.00

Holdings and Investments
H.

TOTAL CASH AND SECURITY HOLDINGS OF PUBLIC EMPLOYEE
RETIREMENT SYSTEM - Sum of totals A through G. . . . . . . . . . . . . . . . . Z81

$

.00

Please continue on the next page
F-11 (10-30-2009)

17119041

§2,{J¤

Page 5

Part 5

REMARKS

Thank you for your report. Please return to

US Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001

This form has been approved by the Office of Management and Budget (OMB) and has been given the number 0607-0585. Please note that
we have displayed this number in the upper right hand corner of this form. Display of this number confirms that we have approval from
OMB to conduct this survey. If this number were not displayed, we could not request your participation in this survey.
Please note that this is a national form that applies to governments with wide differences in size of their service areas, the amount of population
served, and the extent and complexity of their financial accounts. We estimate public reporting burden for this collection of information to vary
from 1.5 to 8.0 hours per response, with an average of 2.0 hours per response, including time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding
this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to
Paperwork Project 0607-0585, US Census Bureau, 4600 Silver Hill Road, Room 3K138, Washington, DC 20233.
You may e-mail comments to paperwork@census.gov; use "Paperwork Project 0607-0585" as the subject.

Census Use Only
F-11 (10-30-2009)

17119058

BEG

REV

EXP

REP

DIFF

V98

END

§2,{[¤