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U.S. DEPARTMENT OF COMMERCE |
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Economics and Statistics Administration |
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U.S. CENSUS BUREAU |
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FORM |
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2008 Supplemental Survey of Locally Administered |
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F-11(S) (2008) |
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Public-Employee Retirement Systems |
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(10/15/2008) |
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OMB No. 0607-0585: Approval Expires 06/30/2010 |
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In correspondence pertaining to this report, please refer to the ID printed above your address. |
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RETURN TO: |
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U.S. Census Bureau |
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1201 East 10th Street |
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Jeffersonville, IN 47132-0001 |
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If you have any questions, |
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please call 1-888-529-1963 |
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weekdays, 8:00 a.m. to |
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5:30 p.m. EST. |
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Questions can also be |
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e-mailed to: |
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govs.retire@census.gov |
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Please correct any errors in name, address, or ZIP Code. |
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INTERNET RESPONSE |
You may respond to this survey via the Internet at the following web address: http://harvester.census.gov/sgfnet |
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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 |
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located on the top line of the address section above. |
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GENERAL INSTRUCTIONS |
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Before filling out this form, please read carefully each part and all related definitions and instructions. |
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Note especially: |
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1. |
Report for Defined Contribution and Postemployment Healthcare plans only. |
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2. |
Report corporate stocks and bonds at market value, and adhere to Governmental Accounting Standards |
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Board (GASB) guidelines when reporting gains and losses on investments. |
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3. |
Report figures relating to all accounts and reserves of your system, including amounts for retirement, |
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disability, survivors, and other benefits, as well as any amounts for administration of the system. |
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Report in whole dollars. Exclude transfers between reserves of the system, and also any investment |
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transactions relating to loans to system members. |
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4. |
Do not delay reporting to await finally audited figures, if substantially accurate figures can be supplied on a |
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preliminary basis. |
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5. |
Use a black or blue ball point pen. |
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RESPONDENT INFORMATION: |
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Name of person completing report - Please print |
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Title of person completing report - Please print |
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Area Code |
Telephone Number |
Extension |
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E-mail Address - Please print |
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Part 1 |
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PLAN INFORMATION FOR DEFINED CONTRIBUTION PLANS |
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A. |
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Does your system offer a defined contribution plan? |
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Yes |
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No |
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If not, skip to part 5. |
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B. |
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Are new employees covered under this pension plan? |
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Yes |
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No |
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C. |
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List all defined contribution plans that your system offers below. |
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Report summary data combining all defined contribution plans. |
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Please continue on the next page |
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Part 2 |
MEMBERSHIP AND BENEFITS FOR DEFINED CONTRIBUTION PLANS |
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Please report the figures requested below, as of the last month of your fiscal year or the month nearest |
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to that permitted by your records. If detailed figures are not available for an item, please enter an |
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estimate and mark it with an asterisk (*). |
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MEMBERS OF YOUR RETIREMENT SYSTEM - |
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Number of |
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Exclude beneficiaries. |
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Participants |
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1. |
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ACTIVE MEMBERS - Current contributors in contributory systems, |
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or employees in non-contributory plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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Z01DC |
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2. |
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INACTIVE MEMBERS - Former employees and employees on military or other |
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extended leave without pay having retained retirement credits, but not currently |
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receiving retirement benefit payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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Z02DC |
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Part 3 |
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RECEIPTS/PAYMENTS FOR DEFINED CONTRIBUTION PLANS |
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A. |
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RECEIPTS DURING FISCAL YEAR - Report receipts for your fiscal year. |
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Exclude amounts received from repayment of loans made to members. |
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Employee |
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1. |
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EMPLOYEE CONTRIBUTIONS - |
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Contributions |
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Total amounts contributed by all member employees or withheld from |
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.00 |
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their salaries for financing benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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X01DC |
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2. |
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EMPLOYER (GOVERNMENT) CONTRIBUTIONS |
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a. |
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From parent local governments - Employer contributions from your |
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government for financing of benefits and parent government |
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Government |
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contributions or appropriations for administration or other |
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Contributions |
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support of the system. Include any local taxes credited directly |
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.00 |
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to your system. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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X04DC |
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b. |
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From other governments - State aid or shared taxes received |
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by the system from the state governments either directly or through |
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the parent local government and amounts received from other |
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.00 |
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local governments on behalf of their employees . . . . . . . . . . . . . . . |
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X05DC |
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3. |
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EARNINGS ON INVESTMENTS - Interest, dividends, rents, and other |
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earnings on investments. Exclude any recorded profits or recorded |
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Investment Earnings and Other Receipts |
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losses on investment transactions and report in Section B below. |
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.00 |
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a. |
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Interest Earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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Z71DC |
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.00 |
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b. |
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Dividend Earnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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Z72DC |
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c. |
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Other Investment Earnings |
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.00 |
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Please specify. . . . . . . . . . . . |
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Z73DC |
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.00 |
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d. |
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Total Earnings on Investments - Sum of items 3a through 3c . . . . . |
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X08DC |
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4. |
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OTHER RECEIPTS - Private gifts |
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.00 |
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or donations, and the like. Specify. . |
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Z95DC |
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Net Gains (Losses) |
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B. |
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NET GAINS/LOSSES ON INVESTMENTS IN MARKET/FAIR VALUE - |
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Z96DC |
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Include both realized and unrealized gains (losses). . . . . . . . . . . . . . . . . . . . . |
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Z91DC |
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C. |
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PAYMENTS DURING FISCAL YEAR - Exclude amounts paid out for |
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purchase of investments and for loans made to members. |
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1. |
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WITHDRAWALS - Amounts paid to employees, former employees, or |
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their survivors, representing return of contributions made by employees |
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.00 |
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during the period of their employment, and any interest on such amounts. . . |
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X12DC |
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.00 |
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2. |
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ADMINISTRATIVE EXPENSES - Include investment fees. . . . . . . . . . . . . . |
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Z93DC |
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.00 |
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3. |
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OTHER PAYMENTS - Specify. . . . |
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Z90DC |
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Please continue on the next page |
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Part 4 |
HOLDINGS AND INVESTMENTS FOR DEFINED CONTRIBUTION PLANS |
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Cash and Short-term Investments |
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A. |
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CASH AND SHORT-TERM INVESTMENTS |
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.00 |
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1. |
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CASH ON HAND AND DEMAND DEPOSITS. . . . . . . . . . . . . . . . . . . . . . |
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Z88DC |
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.00 |
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2. |
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TIME OR SAVINGS DEPOSITS - Include certificates of deposit . . . . . . . . |
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Z87DC |
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3. |
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ALL OTHER SHORT-TERM INVESTMENTS - include securities in |
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repurchase agreements, commercial and finance company |
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paper and bankers acceptances, and miscellaneous |
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.00 |
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money market funds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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Z68DC |
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4. |
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TOTAL CASH AND SHORT-TERM INVESTMENTS - |
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.00 |
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Sum of items A1 through A3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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X21DC |
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B. |
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FEDERAL GOVERNMENT SECURITIES |
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Federal Government Securities |
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1. |
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FEDERAL TREASURY SECURITIES - Obligations of U.S. Treasury |
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.00 |
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(including short-term notes) and Federal Financing Bank. . . . . . . . . . . . . . |
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Z89DC |
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2. |
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FEDERAL AGENCY SECURITIES - Bonds and mortgage-backed |
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securities (where applicable) issued by CCC, Export-Import Bank, |
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FHA, GNMA, Postal Service, and TVA. |
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.00 |
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Report directly held mortgages in Section E below . . . . . . . . . . . . . . . . . . |
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X33DC |
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3. |
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TOTAL FEDERAL GOVERNMENT SECURITIES - |
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.00 |
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Sum of items B1 and B2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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X30DC |
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C. |
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CORPORATE BONDS |
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Corporate Bonds |
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1. |
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FEDERALLY-SPONSORED AGENCIES - Bonds and |
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mortgage-backed securities (where applicable) issued by |
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.00 |
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FHLB, FHLMC, FNMA, Farm credit banks, and SLMA . . . . . . . . . . . . . . . |
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Z62DC |
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2. |
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CORPORATE BONDS, OTHER - Include debentures, convertible |
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.00 |
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bonds, and railroad equipment certificates . . . . . . . . . . . . . . . . . . . . . . . . |
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Z63DC |
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.00 |
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3. |
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TOTAL CORPORATE BONDS - Sum of items C1 and C2. . . . . . . . . . . . . |
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Z77DC |
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Corporate Stocks |
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D. |
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CORPORATE STOCKS - |
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.00 |
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Include common and preferred stocks, and warrants. . . . . . . . . . . . . . . . . . . . . |
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Z78DC |
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E. |
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MORTGAGES HELD DIRECTLY - Exclude mortgage-backed securities, |
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Mortgages Held Directly |
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to be reported at B2, C1, or C2; also exclude directly held real property |
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.00 |
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to be reported at item G1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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X42DC |
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F. |
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OTHER SECURITIES |
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1. |
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INVESTMENTS HELD IN TRUST BY OTHER AGENCIES - |
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Other Securities |
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Include funds administered by private agencies, guaranteed |
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investment accounts, and your share of funds in |
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.00 |
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governmental investment accounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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Z84DC |
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.00 |
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2. |
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STATE AND LOCAL GOVERNMENT SECURITIES . . . . . . . . . . . . . . . . . |
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X35DC |
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3. |
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FOREIGN AND INTERNATIONAL SECURITIES - Include |
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.00 |
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corporate equities and corporate stocks. . . . . . . . . . . . . . . . . . . . . . . . . . |
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Z70DC |
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4. |
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OTHER SECURITIES - Include shares held in mutual funds, conditional |
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sales contracts, direct loans, |
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loans to members, etc. |
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.00 |
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Specify. . . . . . . . . . . . . . . . |
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Z83DC |
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.00 |
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5. |
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TOTAL OTHER SECURITIES - Sum of items F1 through F4 . . . . . . . . . . . |
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X44DC |
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G. |
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OTHER INVESTMENTS |
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Other Investments |
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1. |
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REAL PROPERTY - Report only directly held property; report property held |
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.00 |
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in investment trusts and in pooled or partnership agreements at G2 . . . . . . |
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X46DC |
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2. |
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OTHER INVESTMENTS - Include venture capital, partnerships, |
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real estate investment trusts, |
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and leveraged buy outs - |
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.00 |
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Specify. . . . . . . . . . . . . . . . |
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X47DC |
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.00 |
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3. |
|
TOTAL OTHER INVESTMENTS - Sum of items G1 and G2. . . . . . . . . . . . |
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Z82DC |
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H. |
|
TOTAL CASH AND SECURITY HOLDINGS OF PUBLIC |
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Holdings and Investments |
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EMPLOYEE RETIREMENT SYSTEM - |
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.00 |
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Sum of items A through G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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Z81DC |
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Please continue on the next page |
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Part 5 |
PLAN INFORMATION FOR POSTEMPLOYMENT HEALTHCARE PLANS |
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A. |
|
In addition to the defined contribution plans reported here, |
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does your system offer a postemployment healthcare plan? |
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Yes |
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No |
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If not, skip to Part 9. |
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B. |
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Are new employees covered under this healthcare plan? |
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Yes |
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No |
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C. |
|
List all postemployment healthcare plans that your system offers below. |
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Report summary data combining all postemployment healthcare plans. |
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Part 6 |
MEMBERSHIP AND BENEFITS FOR POSTEMPLOYMENT HEALTHCARE PLANS |
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Please report the figures requested below, as of the last month of your fiscal year |
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or the month nearest to that permitted by your records. If detailed figures are not available for an item, |
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please enter an estimate and mark it with an asterisk (*). |
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|
MEMBERS OF YOUR RETIREMENT SYSTEM - |
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Number of |
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Exclude beneficiaries. |
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Participants |
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1. |
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ACTIVE MEMBERS - Current contributors in contributory systems, |
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or employees in non-contributory plans. |
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a. |
|
Members who are at least 65 years of age. |
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|
Z20HC |
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b. |
|
Members who are under the age of 65. |
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Z21HC |
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c. |
|
Total active members - |
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|
Z01HC |
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|
Sum of items 1a and 1b |
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2. |
|
INACTIVE MEMBERS - Former employees and employees on military or |
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other extended leave without pay having retained retirement credits, |
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but not currently receiving retirement benefit payments. |
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a. |
|
Inactive members who are at least 65 years of age. |
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Z22HC |
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b. |
|
Inactive members who are under the age of 65. |
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Z23HC |
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c. |
|
Total inactive members - |
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|
Z02HC |
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|
Sum of items 2a and 2b |
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Please continue on the next page |
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Part 7 |
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RECEIPTS/PAYMENTS FOR POSTEMPLOYMENT HEALTHCARE PLANS |
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A. |
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RECEIPTS DURING FISCAL YEAR - Report receipts for your fiscal year. |
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Exclude amounts received from repayment of loans made to members. |
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Employee |
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1. |
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EMPLOYEE CONTRIBUTIONS - |
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Contributions |
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Total amounts contributed by all member employees or withheld from |
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.00 |
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their salaries for financing benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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X01HC |
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2. |
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EMPLOYER (GOVERNMENT) CONTRIBUTIONS |
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a. |
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From parent local governments - Employer contributions from your |
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government for financing of benefits and parent government |
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Government |
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contributions or appropriations for administration or other |
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Contributions |
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support of the system. Include any local taxes credited directly |
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.00 |
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to your system. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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X04HC |
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b. |
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From other governments - State aid or shared taxes received |
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by the system from the state governments either directly or through |
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the parent local government and amounts received from other |
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.00 |
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local governments on behalf of their employees . . . . . . . . . . . . . . . |
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X05HC |
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3. |
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EARNINGS ON INVESTMENTS - Interest, dividends, rents, and other |
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earnings on investments. Exclude any recorded profits or recorded |
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Investment Earnings and Other Receipts |
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losses on investment transactions and report in Section B below. |
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.00 |
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a. |
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Interest Earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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Z71HC |
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.00 |
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b. |
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Dividend Earnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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Z72HC |
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c. |
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Other Investment Earnings |
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.00 |
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Please specify. . . . . . . . . . . . |
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Z73HC |
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.00 |
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d. |
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Total Earnings on Investments - Sum of items 3a through 3c . . . . . |
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X08HC |
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4. |
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OTHER RECEIPTS - Private gifts |
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.00 |
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or donations, and the like. Specify. . |
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Z95HC |
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Net Gains (Losses) |
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B. |
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NET GAINS/LOSSES ON INVESTMENTS IN MARKET/FAIR VALUE - |
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Z96HC |
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Include both realized and unrealized gains (losses). . . . . . . . . . . . . . . . . . . . . |
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Z91HC |
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C. |
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PAYMENTS DURING FISCAL YEAR - Exclude amounts paid out for |
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Payments |
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purchase of investments and for loans made to members. |
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.00 |
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1. |
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HEALTHCARE PREMIUMS TO INSURANCE CARRIERS . . . . . . . . . . . |
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Z94HC |
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2. |
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CLAIMS PAID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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Z86HC |
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.00 |
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.00 |
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2. |
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ADMINISTRATIVE EXPENSES - Include investment fees. . . . . . . . . . . . . . |
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Z93HC |
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.00 |
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3. |
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OTHER PAYMENTS - Specify. . . . |
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Z90HC |
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Please continue on the next page |
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Part 8 |
HOLDINGS AND INVESTMENTS FOR POSTEMPLOYMENT HEALTHCARE PLANS |
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Cash and Short-term Investments |
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A. |
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CASH AND SHORT-TERM INVESTMENTS |
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.00 |
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1. |
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CASH ON HAND AND DEMAND DEPOSITS. . . . . . . . . . . . . . . . . . . . . . |
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Z88HC |
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.00 |
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2. |
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TIME OR SAVINGS DEPOSITS - Include certificates of deposit . . . . . . . . |
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Z87HC |
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3. |
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ALL OTHER SHORT-TERM INVESTMENTS - include securities in |
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repurchase agreements, commercial and finance company |
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paper and bankers acceptances, and miscellaneous |
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.00 |
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money market funds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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Z68HC |
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4. |
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TOTAL CASH AND SHORT-TERM INVESTMENTS - |
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.00 |
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Sum of items A1 through A3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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X21HC |
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B. |
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FEDERAL GOVERNMENT SECURITIES |
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Federal Government Securities |
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1. |
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FEDERAL TREASURY SECURITIES - Obligations of U.S. Treasury |
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.00 |
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(including short-term notes) and Federal Financing Bank. . . . . . . . . . . . . . |
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Z89HC |
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2. |
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FEDERAL AGENCY SECURITIES - Bonds and mortgage-backed |
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securities (where applicable) issued by CCC, Export-Import Bank, |
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FHA, GNMA, Postal Service, and TVA. |
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.00 |
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Report directly held mortgages in Section E below . . . . . . . . . . . . . . . . . . |
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X33HC |
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3. |
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TOTAL FEDERAL GOVERNMENT SECURITIES - |
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.00 |
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Sum of items B1 and B2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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X30HC |
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C. |
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CORPORATE BONDS |
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Corporate Bonds |
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1. |
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FEDERALLY-SPONSORED AGENCIES - Bonds and |
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|
|
mortgage-backed securities (where applicable) issued by |
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|
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|
.00 |
|
|
|
|
|
|
FHLB, FHLMC, FNMA, Farm credit banks, and SLMA . . . . . . . . . . . . . . . |
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|
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|
|
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|
|
Z62HC |
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|
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|
|
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|
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|
|
|
|
|
|
|
|
|
2. |
|
CORPORATE BONDS, OTHER - Include debentures, convertible |
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|
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|
|
|
|
|
.00 |
|
|
|
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|
|
bonds, and railroad equipment certificates . . . . . . . . . . . . . . . . . . . . . . . . |
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|
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|
|
Z63HC |
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|
.00 |
|
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|
|
3. |
|
TOTAL CORPORATE BONDS - Sum of items C1 and C2. . . . . . . . . . . . . |
|
|
|
|
|
|
|
|
|
Z77HC |
|
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|
|
Corporate Stocks |
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|
D. |
|
CORPORATE STOCKS - |
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|
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|
|
|
|
|
.00 |
|
|
|
|
Include common and preferred stocks, and warrants. . . . . . . . . . . . . . . . . . . . . |
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|
|
|
|
|
|
|
|
Z78HC |
|
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|
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|
|
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|
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|
|
E. |
|
MORTGAGES HELD DIRECTLY - Exclude mortgage-backed securities, |
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|
|
|
|
|
|
Mortgages Held Directly |
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|
|
to be reported at B2, C1, or C2; also exclude directly held real property |
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|
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|
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|
.00 |
|
|
|
|
to be reported at item G1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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|
|
|
|
|
|
X42HC |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F. |
|
OTHER SECURITIES |
|
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|
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|
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|
|
|
|
|
|
1. |
|
INVESTMENTS HELD IN TRUST BY OTHER AGENCIES - |
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|
|
Other Securities |
|
|
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|
|
Include funds administered by private agencies, guaranteed |
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|
|
investment accounts, and your share of funds in |
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|
.00 |
|
|
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|
|
governmental investment accounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
|
|
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|
Z84HC |
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|
.00 |
|
|
|
|
2. |
|
STATE AND LOCAL GOVERNMENT SECURITIES . . . . . . . . . . . . . . . . . |
|
|
|
|
|
|
|
|
|
X35HC |
|
|
|
|
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|
|
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|
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|
|
|
|
|
|
3. |
|
FOREIGN AND INTERNATIONAL SECURITIES - Include |
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|
.00 |
|
|
|
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|
|
corporate equities and corporate stocks. . . . . . . . . . . . . . . . . . . . . . . . . . |
|
|
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|
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|
Z70HC |
|
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|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4. |
|
OTHER SECURITIES - Include shares held in mutual funds, conditional |
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|
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|
|
sales contracts, direct loans, |
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|
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|
|
loans to members, etc. |
|
|
|
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|
.00 |
|
|
|
|
|
|
Specify. . . . . . . . . . . . . . . . |
|
|
|
|
|
Z83HC |
|
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|
|
|
|
|
|
|
|
|
|
|
|
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|
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|
.00 |
|
|
|
|
5. |
|
TOTAL OTHER SECURITIES - Sum of items F1 through F4 . . . . . . . . . . . |
|
|
|
|
|
|
|
|
|
X44HC |
|
|
|
|
|
|
|
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|
|
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|
|
|
|
|
|
|
|
|
G. |
|
OTHER INVESTMENTS |
|
|
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|
|
Other Investments |
|
|
|
|
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|
|
1. |
|
REAL PROPERTY - Report only directly held property; report property held |
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|
.00 |
|
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|
|
in investment trusts and in pooled or partnership agreements at G2 . . . . . . |
|
|
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|
|
|
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|
X46HC |
|
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|
|
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|
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|
|
|
|
|
|
|
|
|
|
2. |
|
OTHER INVESTMENTS - Include venture capital, partnerships, |
|
|
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|
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|
|
|
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|
|
|
|
|
real estate investment trusts, |
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|
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|
|
|
|
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|
|
and leveraged buy outs - |
|
|
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|
.00 |
|
|
|
|
|
|
Specify. . . . . . . . . . . . . . . . |
|
|
|
|
|
X47HC |
|
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|
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|
.00 |
|
|
|
|
3. |
|
TOTAL OTHER INVESTMENTS - Sum of items G1 and G2. . . . . . . . . . . . |
|
|
|
|
|
|
|
|
|
Z82HC |
|
|
|
|
|
|
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|
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|
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|
|
|
|
|
|
H. |
|
TOTAL CASH AND SECURITY HOLDINGS OF PUBLIC |
|
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|
|
Holdings and Investments |
|
|
|
|
EMPLOYEE RETIREMENT SYSTEM - |
|
|
|
|
|
|
|
|
|
|
|
|
.00 |
|
|
|
|
Sum of items A through G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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|
|
|
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|
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|
Z81HC |
|
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|
Please continue on the next page |
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Part 9 |
REMARKS |
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Thank you for your report. Please return to: |
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U.S. Census Bureau |
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1201 East 10th Street |
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Jeffersonville, IN 47132-0001 |
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This form has been approved by the Office of Management and Budget (OMB) and has been given the number 0607-0585. |
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Please note that we have displayed this number in the upper right hand corner of this form. Display of this number confirms |
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that we have approval from OMB to conduct this survey. If this number were not displayed, we could not request your |
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participation in this survey. |
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Please note that this is a national form that applies to governments with wide differences in size of their service areas, |
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the amount of population served, and the extent and complexity of their financial accounts. We estimate public reporting |
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burden for this collection of information to vary from 1.5 to 8.0 hours per response, with an average of 4.0 hours per response, |
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including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and |
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completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of |
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this collection of information, including suggestions for reducing this burden, to: Paperwork Project 0607-0585, |
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U.S. Census Bureau, 4600 Silver Hill Road, Room 3K138, Washington, D.C. 20233. You may e-mail comments to |
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Paperwork@census.gov; use "Paperwork Project 0607-0585" as the subject. |
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BEG |
REV |
EXP |
END |
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Census Use Only |
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REP |
DIFF |
V98 |
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