Various Economic Area Pretesting Activities

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

2012 Annual Survey of Locally Administered
Public-Employee Retirement Systems

FORM

F-11 (2012)
(07-22-2011) Draft 1

OMB No. 0607-0585: Approval Expires 07/31/2014
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
17112012

§2,5-¤

Page 2

PLAN INFORMATION FOR DEFINED BENEFIT PLANS

Part 1

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 post-employment 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, 2010 and June 30, 2011.
Report for this fiscal year even though a more recent one may be available.
2010

2011

July

October

January

April

August

November

February

May

September

December

March

June

E. 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, 2011 and June 30, 2012.
Report for this fiscal year even though a more recent one may be available.
2011

2012

July

October

January

April

August

November

February

May

September

December

March

June

MEMBERSHIP AND BENEFITS FOR DEFINED BENEFIT PLANS

Part 2

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.

1.

2.

B.

ACTIVE MEMBERS - Current contributors in
contributory systems, or employees in
non-contributory systems.

Z01

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.
a.

Vested

Z__

b.

Non-vested

Z__

c.

Total inactive members Sum of items 2a and 2b

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)

MEMBERS OF YOUR RETIREMENT SYSTEM Exclude beneficiaries.

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
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Page 3

MEMBERSHIP AND BENEFITS FOR DEFINED BENEFIT PLANS - Continued

Part 2
D.

Number
of
Payees
(a)

DROP MEMBERS OF YOUR RETIREMENT SYSTEM Exclude beneficiaries. Provide the number of payees
that are either active or inactive members.
1.

2.

ACTIVE MEMBERS - Current contributors in
contributory systems, or employees in
non-contributory systems.

Z__

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.

Z__

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
$
.00
their salaries for financing benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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. GAINS/LOSSES ON INVESTMENTS IN MARKET/FAIR VALUE Include both realized and unrealized gains (losses).
$

a. Realized gains - book value. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

___

b. Realized losses - book value. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

___

.00

$

Sum of Ba and Bb. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z96
Z91

c. Unrealized gains on investments - market value, net value. . . . . . . . . . . .

___

.00
$

.00

$

.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. . . . . . . . . . . .
Please continue on the next page

X11

F-11 (07-22-2011) Draft 1

17112038

$

.00

$

.00

$

.00

$

.00

$

.00

§2,5G¤

Page 4

Part 3

MEMBERSHIP AND BENEFITS FOR DEFINED BENEFIT PLANS - Continued

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

Part 4

$

.00

$

.00

$

.00

HOLDINGS AND INVESTMENTS FOR DEFINED BENEFIT PLANS
Cash and
Short-term Investments

A. CASH AND SHORT-TERM INVESTMENTS
1. CASH ON HAND AND DEMAND DEPOSITS . . . . . . . . . . . . . . . . . . . . . . .

Z88

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

Z87

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

3. ALL OTHER SHORT-TERM INVESTMENTS - Include securities.
a. Repurchase Agreements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

___

b. Commercial Company Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

___

c. Financial Company Paper. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

___

d. Bankers Acceptances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

___

e. Money Market Mutual Funds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

___

f. Investments Held in Trust Funds - Include shares of collective
intestment funds, short-term investment funds and/or pools, and
employee benefit trust funds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

___

g. Total All Other Short-term Investments . . . . . . . . . . . . . . . . . . . . . . . . . .

Z68

4. TOTAL CASH AND SHORT-TERM INVESTMENTS Sum of items A1 through A3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

X21

Federal Government Securities

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

Z89

2. FEDERAL AGENCY
a. 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 . . . . . . .

X33

b. Federally-Sponsored Agencies - Bonds and mortgage-backed
securities (where applicable) issued by FHLB, FHLMC, FNMA, and
Farm credit banks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z62

c. Total Federal Agencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

___

3. TOTAL FEDERAL GOVERNMENT SECURITIES Sum of items B1 and B2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

X30

$

.00

$

.00

$

.00

$

.00

$

.00

C. CORPORATE BONDS

Corporate Bonds

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

Z62

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

Z63

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

Z77

$

.00

$

.00

$

.00

Corporate Stocks
D. CORPORATE STOCKS Include common and preferred stocks, warrants, private equity, venture
capital, leverage buy-outs, and investments in REITS. . . . . . . . . . . . . . . . . . . .

$

.00

Z78

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Page 5

Part 4

HOLDINGS AND INVESTMENTS FOR DEFINED BENEFIT PLANS - Continued
Mortgages Held Directly

E. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$

.00

X42

F. 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

Other Securities
$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

3. FOREIGN AND INTERNATIONAL SECURITIES - Include
corporate equities and corporate stocks
a. Corporate Foreign Stocks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

___

b. Corporate Foreign Bonds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

___

c. Total Foreign and International Securities
Sum of items 3a and 3b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z70

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

Z83

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

X44

Other Investments

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

$

.00

$

.00

$

.00

$

.00

X46

2. OTHER INVESTMENTS - Include venture capital, partnerships,
real estate investment trusts, state and local government securities,
and leveraged buyouts.
Specify . . . . . . . . . . . . . . . . . .

X47

3. OTHER SECURITIES - Include shares held in conditional
sales contracts, direct loans, foreign currency, derivatives,
guaranteed investment contracts, annuities, life insurance, and
loans to members, etc.
Specify . . . . . . . . . . . . . . . . . .

Z83

4. TOTAL OTHER INVESTMENTS - Sum of items G1 through G3 . . . . . . . .

Z82

Mutual Funds
H. MUTUAL FUNDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$

.00

Z__

Hedge Funds
I.

HEDGE FUNDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$

.00

Z__

Holdings and Investments
J. TOTAL CASH AND SECURITY HOLDINGS OF PUBLIC EMPLOYEE
RETIREMENT SYSTEM - Sum of totals A through I. . . . . . . . . . . . . . . . . . . . .

Part 5

$

.00

Z__

ACTUARIAL INFORMATION FOR DEFINED BENEFIT PLANS

Some of the estimates requested below can be found in the system’s Comprehensive Annual Financial
Report (CAFR) or Actuarial Valuation Report. For instance, the Actuarial Accrued Liability and Covered
Payroll can be obtained from the Schedule of Funding Progress. The Annual Required Contribution can be
obtained from the Schedule of Employer Contributions. GASB mandates that these schedules be published
as part of the Required Supplementary Information to the system’s basic financial statements.
Month Day
Year
A. ACTUARIAL VALUATION DATE - Report the most recent figures that
correspond with the data published in the Solvency Test table of your
Comprehensive Annual Financial Report (CAFR) . . . . . . . . . . . . . . . . . . . . . . . ___
B. Provide an estimate of the pension fund’s Actuarial Accrued
Liability (AAL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$

.00

Z17

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Page 6

ACTUARIAL INFORMATION FOR DEFINED BENEFIT PLANS - (Continued)

Part 5

Report figures requested below, as of the valuation date reported in Part 5, or the most recent figures that
correspond with the data published in the Solvency Test table of your Comprehensive Annual Financial Report
(CAFR). If detailed figures are not available for an item, enter an estimate and mark it with an asterisk (*).
Provide figures on how much of the Actuarial Accrued Liability (AAL) is for members and beneficiaries
of your retirement system.
1. ACTIVE MEMBERS - Current contributors in contributory systems, or
employees in non-contributory systems . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z__

2. 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 . . . . . . . . . . . .

Z__

$

.00

$

.00

Provide figures on how much of the Actuarial Accrued Liability (AAL) is for beneficiaries of your
retirement system.
1. BENEFICIARIES RECEIVING PERIODIC BENEFIT PAYMENTS
DURING MONTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z__

B. Provide an estimate of the pension fund’s Covered Payroll . . . . . . . . . . . .

Z18

C. Provide an estimate of Employer Normal Cost.
Respond as a dollar amount or as a percentage of Covered Payroll. . . . .
(If only Normal Cost is available, provide it instead and check below.)

Z19

1. Member Normal Cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z__

$

.00

$

.00

$

.00

$

.00
OR

%

Reported amount(s) represent Total Normal Cost

V19

D. Provide an estimate of the pension fund’s Annual Required
Contribution (ARC). Respond as a dollar amount or as a
percentage of ARC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$

.00

V10

OR

%
E. Check the Actuarial Cost Method used to produce the above estimates.
Entry Age / Entry Age Normal

Frozen Entry Age

Projected Unit Credit

Frozen Attained Age

Attained Age

Other, Specify

V__
V11

Aggregate

F. Indicate the Investment Rate of Return or Discount Rate used in the actuarial . . . . . . . . . . . . .
G. Are Cost-of-Living Adjustments (COLAs) made to pension benefits after retirement?
Yes - COLA is greater than CPI

Yes - COLA is equal to CPI

Yes - COLA is less than CPI

Yes - Other

Part 6

%
V12

V13

No

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
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V98

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