F-11S Supplemental Survey of Locally Administered Public-Emplo

State & Local Government Finance Forms

f11s.xls

State & Local Government Finance Forms

OMB: 0607-0585

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Overview

F-11(S) Cover, Parts 1
F-11(S) Parts 2 & 3
F-11(S) Part 4
F-11(S) Parts 5 & 6
F-11(S) Part 7
F-11(S) Part 8
F-11(S) Part 9


Sheet 1: F-11(S) Cover, Parts 1




U.S. DEPARTMENT OF COMMERCE




















Economics and Statistics Administration




















U.S. CENSUS BUREAU




















FORM






2008 Supplemental Survey of Locally Administered



F-11(S) (2008)






Public-Employee Retirement Systems



(10/15/2008)




























































OMB No. 0607-0585: Approval Expires 06/30/2010










In correspondence pertaining to this report, please refer to the ID printed above your address.























RETURN TO:















U.S. Census Bureau














1201 East 10th Street














Jeffersonville, IN 47132-0001


























































If you have any questions,




















please 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

































































































































































Please 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.










































GENERAL INSTRUCTIONS






















Before filling out this form, please read carefully each part and all related definitions and instructions.










































Note especially:










































1. Report for Defined Contribution and Postemployment Healthcare plans only.









































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









Title of person completing report - Please print








































































Area Code Telephone Number Extension

E-mail Address - Please print





























































Part 1
PLAN INFORMATION FOR DEFINED CONTRIBUTION PLANS



























A.
Does your system offer a defined contribution plan?










Yes
No





If not, skip to part 5.








































B.
Are new employees covered under this pension plan?










Yes
No

























C.
List all defined contribution plans that your system offers below.




















Report summary data combining all defined contribution plans.





















































































































































































































































































































































































































































































































Please continue on the next page

Sheet 2: F-11(S) Parts 2 & 3


Part 2 MEMBERSHIP AND BENEFITS FOR DEFINED CONTRIBUTION PLANS








































Please report the figures requested below, as of the last month of your fiscal year or the month nearest

















to that permitted by your records. If detailed figures are not available for an item, please enter an

















estimate and mark it with an asterisk (*).






































MEMBERS OF YOUR RETIREMENT SYSTEM -












Number of



Exclude beneficiaries.












Participants






















1.
ACTIVE MEMBERS - Current contributors in contributory systems,

















or employees in non-contributory plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .









Z01DC























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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .









Z02DC













































































Part 3
RECEIPTS/PAYMENTS FOR DEFINED CONTRIBUTION PLANS









































A.
RECEIPTS DURING FISCAL YEAR - Report receipts for your fiscal year.

















Exclude amounts received from repayment of loans made to members.































Employee



1.
EMPLOYEE CONTRIBUTIONS -










Contributions





Total amounts contributed by all member employees or withheld from










.00





their salaries for financing benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . .








X01DC























2.
EMPLOYER (GOVERNMENT) CONTRIBUTIONS




































a.
From parent local governments - Employer contributions from your

















government for financing of benefits and parent government








Government







contributions or appropriations for administration or other








Contributions







support of the system. Include any local taxes credited directly








.00







to your system. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .






X04DC

























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








.00







local governments on behalf of their employees . . . . . . . . . . . . . . .






X05DC























3.
EARNINGS ON INVESTMENTS - Interest, dividends, rents, and other

















earnings on investments. Exclude any recorded profits or recorded










Investment Earnings and Other Receipts





losses on investment transactions and report in Section B below.















































.00





a.
Interest Earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .






Z71DC





































.00





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






Z72DC

























c.
Other Investment Earnings








.00







Please specify. . . . . . . . . . . .






Z73DC





































.00





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






X08DC























4.
OTHER RECEIPTS - Private gifts










.00





or donations, and the like. Specify. .








Z95DC


















Net Gains (Losses)



















B.
NET GAINS/LOSSES ON INVESTMENTS IN MARKET/FAIR VALUE -










Z96DC





Include both realized and unrealized gains (losses). . . . . . . . . . . . . . . . . . . . .










Z91DC








































C.
PAYMENTS DURING FISCAL YEAR - Exclude amounts paid out for

















purchase of investments and for loans made to members.




































1.
WITHDRAWALS - Amounts paid to employees, former employees, or

















their survivors, representing return of contributions made by employees










.00





during the period of their employment, and any interest on such amounts. . .








X12DC





































.00



2.
ADMINISTRATIVE EXPENSES - Include investment fees. . . . . . . . . . . . . .








Z93DC




































.00



3.
OTHER PAYMENTS - Specify. . . .






Z90DC










































































































































































































Please continue on the next page







Sheet 3: F-11(S) Part 4


Part 4 HOLDINGS AND INVESTMENTS FOR DEFINED CONTRIBUTION PLANS


















Cash and Short-term Investments

A.
CASH AND SHORT-TERM INVESTMENTS













































.00



1.
CASH ON HAND AND DEMAND DEPOSITS. . . . . . . . . . . . . . . . . . . . . .








Z88DC


































.00



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








Z87DC





















3.
ALL OTHER SHORT-TERM INVESTMENTS - include securities in
















repurchase agreements, commercial and finance company
















paper and bankers acceptances, and miscellaneous









.00





money market funds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .








Z68DC





















4.
TOTAL CASH AND SHORT-TERM INVESTMENTS -









.00





Sum of items A1 through A3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .








X21DC





































B.
FEDERAL GOVERNMENT SECURITIES











Federal Government Securities





















1.
FEDERAL TREASURY SECURITIES - Obligations of U.S. Treasury









.00





(including short-term notes) and Federal Financing Bank. . . . . . . . . . . . . .








Z89DC





















2.
FEDERAL AGENCY SECURITIES - Bonds and mortgage-backed
















securities (where applicable) issued by CCC, Export-Import Bank,
















FHA, GNMA, Postal Service, and TVA.









.00





Report directly held mortgages in Section E below . . . . . . . . . . . . . . . . . .








X33DC





















3.
TOTAL FEDERAL GOVERNMENT SECURITIES -









.00





Sum of items B1 and B2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .








X30DC





































C.
CORPORATE BONDS





























Corporate Bonds



1.
FEDERALLY-SPONSORED AGENCIES - Bonds and
















mortgage-backed securities (where applicable) issued by









.00





FHLB, FHLMC, FNMA, Farm credit banks, and SLMA . . . . . . . . . . . . . . .








Z62DC





















2.
CORPORATE BONDS, OTHER - Include debentures, convertible









.00





bonds, and railroad equipment certificates . . . . . . . . . . . . . . . . . . . . . . . .








Z63DC


































.00



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








Z77DC


































Corporate Stocks

D.
CORPORATE STOCKS -











.00



Include common and preferred stocks, and warrants. . . . . . . . . . . . . . . . . . . . .










Z78DC





































E.
MORTGAGES HELD DIRECTLY - Exclude mortgage-backed securities,











Mortgages Held Directly



to be reported at B2, C1, or C2; also exclude directly held real property











.00



to be reported at item G1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .










X42DC





































F.
OTHER SECURITIES


































1.
INVESTMENTS HELD IN TRUST BY OTHER AGENCIES -









Other Securities





Include funds administered by private agencies, guaranteed
















investment accounts, and your share of funds in









.00





governmental investment accounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .








Z84DC


































.00



2.
STATE AND LOCAL GOVERNMENT SECURITIES . . . . . . . . . . . . . . . . .








X35DC





















3.
FOREIGN AND INTERNATIONAL SECURITIES - Include









.00





corporate equities and corporate stocks. . . . . . . . . . . . . . . . . . . . . . . . . .








Z70DC





















4.
OTHER SECURITIES - Include shares held in mutual funds, conditional
















sales contracts, direct loans,













loans to members, etc.





.00





Specify. . . . . . . . . . . . . . . .




Z83DC


































.00



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








X44DC





































G.
OTHER INVESTMENTS











Other Investments





















1.
REAL PROPERTY - Report only directly held property; report property held









.00





in investment trusts and in pooled or partnership agreements at G2 . . . . . .








X46DC





















2.
OTHER INVESTMENTS - Include venture capital, partnerships,
















real estate investment trusts,













and leveraged buy outs -





.00





Specify. . . . . . . . . . . . . . . .




X47DC


































.00



3.
TOTAL OTHER INVESTMENTS - Sum of items G1 and G2. . . . . . . . . . . .








Z82DC





































H.
TOTAL CASH AND SECURITY HOLDINGS OF PUBLIC











Holdings and Investments



EMPLOYEE RETIREMENT SYSTEM -











.00



Sum of items A through G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .










Z81DC





























Please continue on the next page
























Sheet 4: F-11(S) Parts 5 & 6


Part 5 PLAN INFORMATION FOR POSTEMPLOYMENT HEALTHCARE PLANS





















A.
In addition to the defined contribution plans reported here,

















does your system offer a postemployment healthcare plan?








Yes
No





If not, skip to Part 9.


































B.
Are new employees covered under this healthcare plan?








Yes
No





















C.
List all postemployment healthcare plans that your system offers below.

















Report summary data combining all postemployment healthcare plans.
































































































































































































































































































































































































































































































































































































































































































































































































































Part 6 MEMBERSHIP AND BENEFITS FOR POSTEMPLOYMENT HEALTHCARE PLANS























Please report the figures requested below, as of the last month of your fiscal year

















or the month nearest to that permitted by your records. If detailed figures are not available for an item,

















please enter an estimate and mark it with an asterisk (*).























































MEMBERS OF YOUR RETIREMENT SYSTEM -












Number of



Exclude beneficiaries.












Participants






















1.
ACTIVE MEMBERS - Current contributors in contributory systems,

















or employees in non-contributory plans.

















a.
Members who are at least 65 years of age.







Z20HC












































b.
Members who are under the age of 65.







Z21HC












































c.
Total active members -







Z01HC








Sum of items 1a and 1b
































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.




































a.
Inactive members who are at least 65 years of age.







Z22HC












































b.
Inactive members who are under the age of 65.







Z23HC












































c.
Total inactive members -







Z02HC








Sum of items 2a and 2b
































































































































































































































































































Please continue on the next page






Sheet 5: F-11(S) Part 7

Part 7
RECEIPTS/PAYMENTS FOR POSTEMPLOYMENT HEALTHCARE PLANS









































A.
RECEIPTS DURING FISCAL YEAR - Report receipts for your fiscal year.

















Exclude amounts received from repayment of loans made to members.































Employee



1.
EMPLOYEE CONTRIBUTIONS -










Contributions





Total amounts contributed by all member employees or withheld from










.00





their salaries for financing benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .








X01HC























2.
EMPLOYER (GOVERNMENT) CONTRIBUTIONS




































a.
From parent local governments - Employer contributions from your

















government for financing of benefits and parent government








Government







contributions or appropriations for administration or other








Contributions







support of the system. Include any local taxes credited directly








.00







to your system. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .






X04HC

























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








.00







local governments on behalf of their employees . . . . . . . . . . . . . . .






X05HC























3.
EARNINGS ON INVESTMENTS - Interest, dividends, rents, and other

















earnings on investments. Exclude any recorded profits or recorded










Investment Earnings and Other Receipts





losses on investment transactions and report in Section B below.


































































.00





a.
Interest Earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .






Z71HC





































.00





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






Z72HC

























c.
Other Investment Earnings








.00







Please specify. . . . . . . . . . . .






Z73HC





































.00





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






X08HC























4.
OTHER RECEIPTS - Private gifts










.00





or donations, and the like. Specify. .








Z95HC


















Net Gains (Losses)



















B.
NET GAINS/LOSSES ON INVESTMENTS IN MARKET/FAIR VALUE -










Z96HC





Include both realized and unrealized gains (losses). . . . . . . . . . . . . . . . . . . . .










Z91HC








































C.
PAYMENTS DURING FISCAL YEAR - Exclude amounts paid out for












Payments



purchase of investments and for loans made to members.































.00



1.
HEALTHCARE PREMIUMS TO INSURANCE CARRIERS . . . . . . . . . . .








Z94HC










































2.
CLAIMS PAID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .








Z86HC
.00























































.00



2.
ADMINISTRATIVE EXPENSES - Include investment fees. . . . . . . . . . . . . .








Z93HC




































.00



3.
OTHER PAYMENTS - Specify. . . .






Z90HC

































































































































































































































































































































































































































































Please continue on the next page







Sheet 6: F-11(S) Part 8


Part 8 HOLDINGS AND INVESTMENTS FOR POSTEMPLOYMENT HEALTHCARE PLANS


















Cash and Short-term Investments

A.
CASH AND SHORT-TERM INVESTMENTS













































.00



1.
CASH ON HAND AND DEMAND DEPOSITS. . . . . . . . . . . . . . . . . . . . . .








Z88HC


































.00



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








Z87HC





















3.
ALL OTHER SHORT-TERM INVESTMENTS - include securities in
















repurchase agreements, commercial and finance company
















paper and bankers acceptances, and miscellaneous









.00





money market funds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .








Z68HC





















4.
TOTAL CASH AND SHORT-TERM INVESTMENTS -









.00





Sum of items A1 through A3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .








X21HC





































B.
FEDERAL GOVERNMENT SECURITIES











Federal Government Securities





















1.
FEDERAL TREASURY SECURITIES - Obligations of U.S. Treasury









.00





(including short-term notes) and Federal Financing Bank. . . . . . . . . . . . . .








Z89HC





















2.
FEDERAL AGENCY SECURITIES - Bonds and mortgage-backed
















securities (where applicable) issued by CCC, Export-Import Bank,
















FHA, GNMA, Postal Service, and TVA.









.00





Report directly held mortgages in Section E below . . . . . . . . . . . . . . . . . .








X33HC





















3.
TOTAL FEDERAL GOVERNMENT SECURITIES -









.00





Sum of items B1 and B2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .








X30HC



















C.
CORPORATE BONDS





























Corporate Bonds



1.
FEDERALLY-SPONSORED AGENCIES - Bonds and
















mortgage-backed securities (where applicable) issued by









.00





FHLB, FHLMC, FNMA, Farm credit banks, and SLMA . . . . . . . . . . . . . . .








Z62HC





















2.
CORPORATE BONDS, OTHER - Include debentures, convertible









.00





bonds, and railroad equipment certificates . . . . . . . . . . . . . . . . . . . . . . . .








Z63HC


































.00



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








Z77HC


































Corporate Stocks

D.
CORPORATE STOCKS -











.00



Include common and preferred stocks, and warrants. . . . . . . . . . . . . . . . . . . . .










Z78HC



















E.
MORTGAGES HELD DIRECTLY - Exclude mortgage-backed securities,











Mortgages Held Directly



to be reported at B2, C1, or C2; also exclude directly held real property











.00



to be reported at item G1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .










X42HC



















F.
OTHER SECURITIES


































1.
INVESTMENTS HELD IN TRUST BY OTHER AGENCIES -









Other Securities





Include funds administered by private agencies, guaranteed
















investment accounts, and your share of funds in









.00





governmental investment accounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .








Z84HC


































.00



2.
STATE AND LOCAL GOVERNMENT SECURITIES . . . . . . . . . . . . . . . . .








X35HC





















3.
FOREIGN AND INTERNATIONAL SECURITIES - Include









.00





corporate equities and corporate stocks. . . . . . . . . . . . . . . . . . . . . . . . . .








Z70HC





















4.
OTHER SECURITIES - Include shares held in mutual funds, conditional
















sales contracts, direct loans,













loans to members, etc.





.00





Specify. . . . . . . . . . . . . . . .




Z83HC


































.00



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








X44HC



















G.
OTHER INVESTMENTS











Other Investments





















1.
REAL PROPERTY - Report only directly held property; report property held









.00





in investment trusts and in pooled or partnership agreements at G2 . . . . . .








X46HC





















2.
OTHER INVESTMENTS - Include venture capital, partnerships,
















real estate investment trusts,













and leveraged buy outs -





.00





Specify. . . . . . . . . . . . . . . .




X47HC


































.00



3.
TOTAL OTHER INVESTMENTS - Sum of items G1 and G2. . . . . . . . . . . .








Z82HC



















H.
TOTAL CASH AND SECURITY HOLDINGS OF PUBLIC











Holdings and Investments



EMPLOYEE RETIREMENT SYSTEM -











.00



Sum of items A through G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .










Z81HC











Please continue on the next page






Sheet 7: F-11(S) Part 9


Part 9 REMARKS


























































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































Thank you for your report. Please return to:







U.S. 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 4.0 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,
























U.S. Census Bureau, 4600 Silver Hill Road, Room 3K138, Washington, D.C. 20233. You may e-mail comments to
























Paperwork@census.gov; use "Paperwork Project 0607-0585" as the subject.


























































BEG REV EXP END






















Census Use Only
REP DIFF V98





































































































































































































File Typeapplication/vnd.ms-excel
Authorbecke310
Last Modified Bysmith056
File Modified2008-03-21
File Created2007-04-24

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