F-12S Supplemental Survey of State-Administered Public-Employe

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
FORM

F-12(S) (2007)
(10-24-2007)

2007 Census of Governments Supplemental Survey of State
Administered Public-Employee Retirement Systems
OMB No. 0607-0585: Approval Expires 06/30/2008
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:
[email protected]

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

E-mail Address - Please print

Telephone Number

-

Part 1

Extension

-

PLAN INFORMATION FOR DEFINED CONTRIBUTION PLANS

A.

Does your system offer a defined contribution plan?
If not, skip to Part 5.

Yes

No

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
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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 (*).
Number of
MEMBERS OF YOUR RETIREMENT SYSTEM Participants
Exclude beneficiaries.
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.
1. EMPLOYEE CONTRIBUTIONS Total amounts contributed by all member employees or withheld from
their salaries for financing benefits.
a. State employees - From employees of the state government,
including employees of state colleges and other state institutions
and agencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X02DC
b. Local employees - From employees of the counties, cities,
local public schools, and other local government agencies. . . . . . . . . X01DC

Employee Contributions
$

.00

$

.00

2. EMPLOYER (GOVERNMENT) CONTRIBUTIONS - Total amounts
received from state and local governments for financial support of your
system, including any taxes credited directly to the system.
Government Contributions

a. State government contributions - From state government, including
state colleges and other state institutions and agencies.
1. State contributions to own system on behalf of state employees. . Z99DC
2. State contributions to own system on behalf of local employees. .

V87DC

3. Total State Contributions - Sum of items 2a1 and 2a2. . . . . . . .

X06DC

b. Local government contributions - From counties, cities, local public
schools, and other local government agencies. . . . . . . . . . . . . . . . . X05DC

$

.00

$

.00

$

.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. Rentals from the state government. . . . . . . . . . . . . . . . . . . . . . . . . . Z98DC
b. Interest Earnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z71DC
c. Dividend Earnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z72DC
d. Other Investment Earnings
Specify. . . . . . . . . . . . . . . . . . .

Z73DC

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

X08DC

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

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

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.

.00

Payments

1. 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. . . . . . . . . . . . . X12DC
2. ADMINISTRATIVE EXPENSES - Include investment fees. . . . . . . . . .

Z93DC

3. OTHER PAYMENTS - Specify. . . .

Z90DC

$

.00

$

.00

$

.00

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HOLDINGS AND INVESTMENTS FOR
DEFINED CONTRIBUTION PLANS

Part 4
A.

CASH AND SHORT-TERM INVESTMENTS
1. CASH ON HAND AND DEMAND DEPOSITS . . . . . . . . . . . . . . . . . . Z88DC
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
money market funds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z68DC

4.

B.

TOTAL CASH AND SHORT-TERM INVESTMENTS Sum of items A1 through A3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X21DC

$

.00

$

.00

$

.00

$

.00

Federal Government Securities

FEDERAL GOVERNMENT SECURITIES
1.

FEDERAL TREASURY SECURITIES - Obligations of U.S. Treasury
(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.
Report directly held mortgages in Section E below. . . . . . . . . . . . . . . X33DC

3.
C.

Cash and
Short-term Investments

TOTAL FEDERAL GOVERNMENT SECURITIES Sum of items B1 and B2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X30DC

$

.00

$

.00

$

.00

CORPORATE BONDS
1.

Corporate Bonds

FEDERALLY-SPONSORED AGENCIES - Bonds and
mortgage-backed securities (where applicable) issued by
FHLB, FHLMC, FNMA, Farm credit banks, and SLMA. . . . . . . . . . . . . Z62DC

$

.00

2.

CORPORATE BONDS, OTHER - Include debentures, convertible
bonds, and railroad equipment certificates. . . . . . . . . . . . . . . . . . . . . Z63DC

$

.00

3.

TOTAL CORPORATE BONDS - Sum of items C1 and C2. . . . . . . . . . Z77DC

$

.00
Corporate Stocks

D.

CORPORATE STOCKS Include common and preferred stocks, and warrants. . . . . . . . . . . . . . . . . Z78DC

$

.00

Mortgages Held Directly
E.

F.

MORTGAGES HELD DIRECTLY - Exclude mortgage-backed securities,
to be reported at B2, C1, or C2; also exclude directly held real property
to be reported at item G1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X42DC
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. . . . . . . . . . . . . . . . . . . . . . . . . . . Z84DC
2.

STATE AND LOCAL GOVERNMENT SECURITIES. . . . . . . . . . . . . . X35DC

3.

FOREIGN AND INTERNATIONAL SECURITIES - Include
corporate equities and corporate stocks. . . . . . . . . . . . . . . . . . . . . . . Z70DC

4.

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

5.
G.

$

Other Securities
$

.00

$

.00

$

.00

$

.00

$

.00

Z83DC

TOTAL OTHER SECURITIES - Sum of items F1 through F4. . . . . . . . X44DC

Other Investments

OTHER INVESTMENTS
1.

REAL PROPERTY - Report only directly held property; report property held
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 buyouts.
Specify. . . . . . . . . . . . . . . .

3.

.00

X47DC

TOTAL OTHER INVESTMENTS - Sum of items G1 and G2. . . . . . . . Z82DC

$

.00

$

.00

$

.00
Holdings and Investments

H.

TOTAL CASH AND SECURITY HOLDINGS OF PUBLIC EMPLOYEE
RETIREMENT SYSTEM - Sum of totals A through G. . . . . . . . . . . . . . . . Z81DC

$

.00

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Part 5

PLAN INFORMATION FOR POSTEMPLOYMENT HEALTHCARE PLANS

A.

Does your system offer a postemployment healthcare plan? . . . . . . . . . . . . . . .
If not, skip to Part 9.

Yes

No

B.

Are new employees covered under this pension 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 Exclude beneficiaries.
1.

Number of
Participants

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 Sum of items 1a and 1b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z01HC
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 Sum of items 2a and 2b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z02HC

Please continue on the next page
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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.
1. EMPLOYEE CONTRIBUTIONS Total amounts contributed by all member employees or withheld from
their salaries for financing benefits.
a. State employees - From employees of the state government,
including employees of state colleges and other state institutions
and agencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X02HC
b. Local employees - From employees of the counties, cities,
local public schools, and other local government agencies. . . . . . . . . X01HC

Employee Contributions
$

.00

$

.00

2. EMPLOYER (GOVERNMENT) CONTRIBUTIONS - Total amounts
received from state and local governments for financial support of your
system, including any taxes credited directly to the system.
Government Contributions

a. State government contributions - From state government, including
state colleges and other state institutions and agencies.
1. State contributions to own system on behalf of state employees. .

Z99HC

2. State contributions to own system on behalf of local employees. .

V87HC

3. Total State Contributions - Sum of items 2a1 and 2a2. . . . . . . .

X06HC

b. Local government contributions - From counties, cities, local public
schools, and other local government agencies. . . . . . . . . . . . . . . . . X05HC

$

.00

$

.00

$

.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. Rentals from the state government. . . . . . . . . . . . . . . . . . . . . . . . . .

Z98HC

b. Interest Earnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z71HC

c. Dividend Earnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z72HC

d. Other Investment Earnings
Specify. . . . . . . . . . . . . . . . . . .

Z73HC

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

X08HC

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

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

Z95HC

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

Z96HC
Z91HC

$

C. PAYMENTS DURING FISCAL YEAR - Exclude amounts paid out for
purchase of investments and for loans made to members.

.00

Payments

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

Z94HC

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

Z95HC

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

Z93HC

4. OTHER PAYMENTS - Specify. . . .

Z90HC

$

.00

$

.00

$

.00

$

.00

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Part 8
A.

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
money market funds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z68HC
TOTAL CASH AND SHORT-TERM INVESTMENTS Sum of items A1 through A3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X21HC

$

.00

$

.00

$

.00

$

.00

Federal Government Securities

FEDERAL GOVERNMENT SECURITIES
1.

FEDERAL TREASURY SECURITIES - Obligations of U.S. Treasury
(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.
Report directly held mortgages in Section E below. . . . . . . . . . . . . . . X33HC

3.
C.

Cash and
Short-term Investments

CASH AND SHORT-TERM INVESTMENTS
1. CASH ON HAND AND DEMAND DEPOSITS . . . . . . . . . . . . . . . . . . Z88HC

4.

B.

HOLDINGS AND INVESTMENTS FOR
POSTEMPLOYMENT HEALTHCARE PLANS

TOTAL FEDERAL GOVERNMENT SECURITIES Sum of items B1 and B2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X30HC

$

.00

$

.00

$

.00

CORPORATE BONDS
1.

Corporate Bonds

FEDERALLY-SPONSORED AGENCIES - Bonds and
mortgage-backed securities (where applicable) issued by
FHLB, FHLMC, FNMA, Farm credit banks, and SLMA. . . . . . . . . . . . . Z62HC

$

.00

2.

CORPORATE BONDS, OTHER - Include debentures, convertible
bonds, and railroad equipment certificates. . . . . . . . . . . . . . . . . . . . . Z63HC

$

.00

3.

TOTAL CORPORATE BONDS - Sum of items C1 and C2. . . . . . . . . . Z77HC

$

.00
Corporate Stocks

D.

CORPORATE STOCKS Include common and preferred stocks, and warrants. . . . . . . . . . . . . . . . . Z78HC

$

.00

Mortgages Held Directly
E.

F.

MORTGAGES HELD DIRECTLY - Exclude mortgage-backed securities,
to be reported at B2, C1, or C2; also exclude directly held real property
to be reported at item G1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X42HC
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. . . . . . . . . . . . . . . . . . . . . . . . . . . Z84HC
2.

STATE AND LOCAL GOVERNMENT SECURITIES. . . . . . . . . . . . . . X35HC

3.

FOREIGN AND INTERNATIONAL SECURITIES - Include
corporate equities and corporate stocks. . . . . . . . . . . . . . . . . . . . . . . Z70HC

4.

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

5.
G.

$

Other Securities
$

.00

$

.00

$

.00

$

.00

$

.00

Z83HC

TOTAL OTHER SECURITIES - Sum of items F1 through F4. . . . . . . . X44HC

Other Investments

OTHER INVESTMENTS
1.

REAL PROPERTY - Report only directly held property; report property held
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 buyouts.
Specify. . . . . . . . . . . . . . . .

3.

.00

X47HC

TOTAL OTHER INVESTMENTS - Sum of items G1 and G2. . . . . . . . Z82HC

$

.00

$

.00

$

.00
Holdings and Investments

H.

TOTAL CASH AND SECURITY HOLDINGS OF PUBLIC EMPLOYEE
RETIREMENT SYSTEM - Sum of totals A through G. . . . . . . . . . . . . . . . Z81HC

$

.00

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Part 9

REMARKS

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 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, U.S. Census Bureau, 4600 Silver Hill Road, Room 3K138, Washington, D.C. 20233.
You may e-mail comments to [email protected]; use "Paperwork Project 0607-0585" as the subject.

Thank you for your report. Please return to:

Census Use Only

BEG

REV

EXP

REP

DIFF

V98

END

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