Various Governments Area Pretesting Activities

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
(8-4-2010)

FORM

F-12

2012 CENSUS OF GOVERNMENTS
SURVEY OF PUBLIC PENSIONS
State Administered Defined Benefit Plans

(12-14-2011) Draft 4

OMB No. 0607-0585: Approval Expires 06/30/2014

DUE DATE:

RETURN TO:
U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001

Need help or have
questions?
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census.gov/govs/cog2012/
cog_finance.html
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In correspondence pertaining
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GENERAL INSTRUCTIONS

1.

To complete this form, you will need the Comprehensive Annual Financial Report (CAFR) and the most recent
actuarial report for the retirement system listed in the mailing address. (Use the annual report if the retirement
system does not have a CAFR.)

2.

Report figures for Defined Benefit plans only. Do not include Defined Contribution or Healthcare plans in your
data.

3.

If you are including data for any retirement system(s) administered in addition to the system identified in
the address box above, list retirement system(s) in the Remarks section at the end of the form.

4.

Report corporate stocks and bonds at market value, and adhere to Governmental Accounting Standards Board
(GASB) guidelines when reporting gains and losses on investments.

5.

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. Exclude transfers between
reserves of the system, and also any loans to system members.

6.

Do not delay reporting to await final figures, if substantially accurate figures can be supplied on a preliminary
basis.

7.

Use a black or blue ball point pen. Do not use pencil or felt-tip pen.

Please continue on the next page

17122011

§2-5,¤

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

Page 2

1

Is your addressee title/department and mailing address the same as shown in the address label?
Yes – Go to 2

No – Enter correct information below

Addressee Title or Department

Street 1

Street 2

City

State

Zip Code

–

PART 1 – RETIREMENT SYSTEM COVERAGE AND ORGANIZATIONAL INFORMATION
2

Which one of the following best describes your retirement system? Mark "X" only one box.
A.

All contributions for retirement are forwarded to a private insurance carrier as premiums paid for
the purchase of annuity policies for the members of your plan.

B.

All members of your plan belong to the Teachers Insurance and Annuity Association (TIAA) without
any State or locally administered supplemental retirement coverage.

C.

Payments of service, disability, or survivor benefits are paid directly from the general funds of the
administering government to the beneficiary. There is no seperate retirement system fund.

PART 2 – PLAN INFORMATION FOR DEFINED BENEFIT PLANS
3

Are new employees covered under this defined benefit plan?
Yes

4

In addition to the defined benefit plan reported on this form, does this public retirement system offer
a defined contribution plan?
Yes

5

No

In addition to the defined benefit plan reported on this form, does this public retirement system offer
a postemployment healthcare plan?
Yes

No

PART 3 – ENDING DATE OF FISCAL YEAR

6

What is the retirement system’s fiscal year end date? . . . . . . . . . . . . . . . . . . . .

7

What was the retirement system’s latest fiscal year end date that occured
before July 1, 2012? Use this fiscal year data to complete the remainder of this
form even though more recent data may be available . . . . . . . . . . . . . . . . . . . . . . . .

Form F-12

MM

DD

YY

MM

DD

YY

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17122029

§2-5>¤

No

Page 3
PART 4 – MEMBERSHIP AND BENEFITS FOR DEFINED BENEFIT PLANS

HOW TO
REPORT
DOLLAR
FIGURES

8

CORRECT marking example –
Please print all information clearly in ordinary
characters. (Use care to keep characters in their
respective boxes.)
$Bil.

Mil.

Thou.

Dol.

1 2 3

4 5 6

7 8 0

INCORRECT marking example –
Do not put slashes through "0" or "7".
$Bil.

Mil.

Thou.

Dol.

7

8 9 0

What was the total number of members of your retirement system during the last month of the fiscal
year indicated in 7 ?
Exclude
• Beneficiaries
A. Active members – Current contributors in contributory
systems or employees in non-contributory systems.
1.

Employed by your state government
Include
• State institutions and agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.

Employed by your local governments
Include
• Local agencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.

TOTAL - (Sum of items A1. through A2.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z01

B. 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.
1. Vested . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9

2.

Non-vested . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.

TOTAL - (Sum of items B1. through B2.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of
Members

Z02

What was the total number of retirees and beneficiaries and payments made during the last month of
the fiscal year indicated in 7 ? Provide estimates if detailed data are not available.
Number of
Amount Paid
Retirees/
during Month
Beneficiaries
Dol.
$Bil.
Mil.
Thou.
A. Former active members of

B.

system, retired on account
of age or service . . . . . . . . Z03

Z08

Former active members of
system, retired on account
of disability . . . . . . . . . . . . Z04

Z09

C. Survivors of deceased
former active members . . .

10

Z05

Z10

What was the total number of payees and amount of lump-sum payments made during the fiscalyear
indicated in 7 ?
Number of
Amount Paid
Payees
during Month
A. Withdrawals and other one
Dol.
$Bil.
Mil.
Thou.
time payments made to

B.

members of a deferred
retirement option plan
(DROP) . . . . . . . . . . . . . . . . . .

Z11

Withdrawals and other one time
payments (other than loans) made
to present or former members of system
Exclude
• Payment to DROP members
(reported in A. above) . . . . . .

Z12

4 on the next page
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Form F-12

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17122037

§2-5F¤

Number of
Members

Page 4
Number of
Payees
$Bil.

C. Lump-sum (nonrecurrent)

Amount Paid
during Month
Mil.
Thou.

Dol.

payments made to survivors
of deceased former active
members . . . . . . . . . . . . . . . .

PART 5 – RECEIPTS/PAYMENTS FOR DEFINED BENEFIT PLANS
11

What was the amount of receipts during the fiscal year indicated in 7 ?
Exclude
• Amounts received from repayment of loans made to members
A. Employee contributions – Total amounts contributed by
all member employees or withheld from their salaries for
financing benefits
1.

2.

State employees - From employees of the state
government, including employees of state colleges
and other state institutions and agencies . . . . . . . . . . . . .

X01

Local employees - From employees of the counties,
cities, local public schools, and other local
government agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . .

X02

B. 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.
1.

State government contributions
a. State contributions to own system on behalf of
state employees. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b.

c.
2.

$Bil.

Employee Contributions
Mil.
Thou.
Dol.

$Bil.

Employer (Government)
Contributions
Mil.
Thou.
Dol.

Z99

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

V87

TOTAL - (Sum of items 1a. through 1b.)

X06

..........
Local government contributions – From counties,
cities, local public schools, and other local
government agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . X05

1.

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

Z98

2.

Interest earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z71

3.

Dividend earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z72

4.

Other investment earnings – Specify: C

5.

..

Z73

TOTAL - (Sum of items C1. through C4.) . . . . . . . . . . . . .

X08

Dol.

17122045

§2-5N¤

C. Earnings on investments – Interest, dividends, rents,
and other earnings on investments.
Include
Exclude
• Interst
• Recorded profits on investments
• Dividends
transactions (report in section E.)
• Rents
• Recorded losses on investments
• Other earnings on investments
transactions (report in section E.)
Investment Earnings
$Bil.
Mil.
Thou.

4 on the next page
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Form F-12

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Page 5

D. Other receipts
Include
• Private gifts
• Donations
Specify:

E.

12

Other Receipts
Thou.

$Bil.

Mil.

$Bil.

Gains and Losses
Mil.
Thou.

Dol.

.....

Gains and losses on investments

1.

Realized gains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.

Realized losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.

Realized gains/losses (items E1. – E2.) . . . . . . . . . . . . . . .

4.

Unrealized net gains or losses on investments . . . . . . . . . . .

Dol.

Z96
Z91

What was the amount of payments during the fiscal yearindicated in 7 ?
Exclude
• Amounts paid out for purchase of investments
• Loans made to members

$Bil.

Mil.

Payments
Thou.

Dol.

1.

Retirement benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z13

2.

Disability benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z14

3.

Survivor benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z15

4.

Other benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z16

5.

TOTAL - (Sum of items A1. through A4.). . . . . . . . . . . . .

X11

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

X12

17122052

§2-5U¤

A. Benefit payment – Report annual amounts

C. Administrative expenses
Include
• Investment fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z93

D. Other payments – Specify: C
..

Form F-12

Z90

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Page 6
PART 6 – CASH AND INVESTMENTS FOR DEFINED BENEFIT PLANS
13

What was the amount of cash and investments during the fiscal year indicated in 7 ?
Cash and Short-term
Investments
Mil.
Thou.

$Bil.

Dol.

A. Cash and short-term investments
1.

Cash on hand and demand deposits . . . . . . . . . .

Z88

2.

Time or savings deposits . . . . . . . . . . . . . . . . . . .

Z87

3.

All other short-term investments

4.

a.

Repurchase agreements . . . . . . . . . . . . . . . . . . .

b.

Commercial company paper . . . . . . . . . . . . . . . .

c.

Financial company paper . . . . . . . . . . . . . . . . . .

d.

Bankers acceptances . . . . . . . . . . . . . . . . . . . . . .

e.

Money market mutual funds . . . . . . . . . . . . . . . .

f.

Investments held in trust funds
Include
• Shares of collective investment funds
• Short-term investment funds and/or pools
• Employee benefit trust funds . . . . . . . . . . . .

g.

TOTAL - (Sum of items A3a. through A3f.). . . . .

TOTAL - (Sum of items A1. through A3.) . . . . . . .

X68

B. Federal government securities
1.

Federal treasury securities – Obligations of the
US Treasury and Federal Financing Bank

$Bil.

Federal Government Securities
Mil.
Thou.
Dol.

Include
• Short-term notes . . . . . . . . . . . . . . . . . . . . . . Z89
Federal agency
a. Securities – Bonds and mortgage-backed
securities (where applicable) issued by
CCC, Export-Import Bank, FHA, GNMA,
Postal Service, and TVA. Report directly
held mortgages in Section E below . . . . . . . .
b.

3.

X33

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

Z62

TOTAL - (Sum of items B1. through B2.) . . . . . . .

X30

17122060

§2-5]¤

2.

4 on the next page
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Form F-12

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Page 7

C. Corporate bonds, domestic
Include
• Debentures
• Convertible bonds
• Railroad equipment certificates
• Assets backed securities
• Commercial mortgage backed securities
• Corporate collateralized mortgage backed
securities
• Private debt and SLM Corporation . . . . . . . . . . . .

$Bil.

Corporate Bonds
Mil.
Thou.

Dol.

$Bil.

Corporate Stocks
Mil.
Thou.

Dol.

$Bil.

Foreign and
International Securities
Mil.
Thou.

Dol.

$Bil.

Mortgages Held Directly
Mil.
Thou.

Dol.

$Bil.

Other Securities
Mil.
Thou.

Dol.

$Bil.

Mutual Funds
Mil.
Thou.

Dol.

$Bil.

Hedge Funds
Mil.
Thou.

Dol.

Z63

D. Corporate stocks, domestic
Include
• Common and preferred stocks
• Warrants
• Private equity
• Venture capital
• Leverage buy-outs
• Investments in REITs
Exclude
• Short term money market mutual funds (reported
in A3c. above)
• Other mutual funds (report in H.)
• Hedge funds (report in I.) . . . . . . . . . . . . . . . . . . .
E.

Z78

Foreign and international securities
Include
• Corporate equities
• Corporate stocks
Exclude
• Foreign governmernt (report in J.)

F.

1.

Corporate foreign stocks . . . . . . . . . . . . . . . . . . . . . .

2.

Corporate foreign bonds . . . . . . . . . . . . . . . . . . . . . .

3.

TOTAL - (Sum of items 2a. through 2b.) . . . . . . .

Z70

Mortgages held directly
Exclude
• Mortgage-backed securities (to be reported in
items B2., C1.)
• Directly held real property (report in item G1.) . . .

X42

Include
• Funds administered by private agencies
• Guaranteed investment accounts
• Your share of funds in governmental
investment accounts. . . . . . . . . . . . . . . . . . . . . . .

Z84

H. Mutual funds
Exclude
• Short term money market mutual funds (reported
in A3e.)
• Hedge funds (report in I.) . . . . . . . . . . . . . . . . . . . . .

I.
Form F-12

Hedge funds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 on the next page
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17122078

§2-5o¤

G. Other non-governmental securities

Page 8

J.

Other investments
1.

Real property – Report only directly held property.
(Report property held in investment trusts and in
pooled or partnership agreements in item G2.). . . X46

2.

Other investments
Include
• Partnerships
• State and local government securities

3.

Other securities
Include
• Shares held in conditional sales contracts
• Direct loans
• Foreign currency
• Foreign governments
• Derivatives
• Guaranteed investment contracts
• Annuities
• Life insurance
• Loans to members

Specify:

Specify:

4.

..

X47

..

Z83

$Bil.

Other Investments
Mil.
Thou.

Dol.

$Bil.

Holdings and Investments
Mil.
Thou.

Dol.

TOTAL - (Sum of items G1. through G3.) . . . . . . . Z82

K. TOTAL - (Sum of totals A. through I.). . . . . . . . . . . . .

Z81

PART 7 – ACTUARIAL INFORMATION FOR DEFINED BENEFIT PLANS
(MM)

(DD)

14

What is the date for your Actuarial Valuation Report?
Report the data for the Actuarial Valuation Report that corresponds
to the fiscal year reported in 7 ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15

What is the amount of funds associated with the Actuarial Accrued Liability (ALL)?

(YYYY)

A. Estimate of pension fund’s Actuarial Accrued
Liability – This value can be obtained from the
Schedule of Funding Progress report . . . . . . . . . . . . .

Z17

B. Membership amounts – Amount of the
Actuarial Accrued Liability (AAL) for members
and beneficiaries of your pension system

Form F-12

1.

Active members - Current contributors in
contributory systems, or employees in
noncontributory systems . . . . . . . . . . . . . . . . . . . . . .

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

3.

Beneficiaries receiving periodic benefit
payments during month. . . . . . . . . . . . . . . . . . . . . . .

17122086

§2-5w¤

Actuarial Accrued Liability Amount
$Bil.
Mil.
Thou.
Dol.

Please continue on the next page

Page 9

16

17

What is the amount of covered payroll? This value can be obtained from the Schedule of Funding
Progress report.
Covered Payroll
$Bil.
Mil.
Thou.

Dol.

What is the amount of Employer Normal Cost or Service Cost? Report as a dollar amount or percentage
of Covered Payroll. If only Normal Cost is available, report that value instead and mark "X" box below.
Normal or Service Cost
$Bil.
Mil.
Thou.
Dol.

OR

%

Reported amount represents Total Normal Cost

18

Are members required to contribute to the Normal Cost or Service Cost?
Yes
Percentage of
Covered Payroll
Contributed

No - Go to 20

19

What percentage of Covered Payroll are members required to contribute? . . . . . . . . . . . .

20

What is the amount of the pension fund’s Annual Required contribution (ARC)? This value can be
obtained from the Schedule of Employer Contributions report.
Annual Required Contribution
$Bil.
Mil.
Thou.
Dol.

%

Z10

21

What is the Actuarial Cost Method used to produce the above estimates? Mark "X" only one box.
Entry Age / Entry Age Normal
Projected Unit Credit

§2-5¡¤

Attained Age

17122094

Aggregate
Frozen Entry Age
Frozen Attained Age
Other – Specify:

22

What is the Investment Rate of Return or Discount Rate used in the actuarial valuation?
Investment Rate
or Discount Rate

%
Form F-12

Page 10

23

Were Cost-of-Living Adjustments (COLA) made to pension benefits after retirement for fiscal year
reported in 7 ? Mark "X" all that apply.
*If more than one box is selected, explain different options in PART 8 - REMARKS.
Yes – COLA is greater than CPI
Yes – COLA is less than CPI
Yes – COLA is equal to CPI
Yes – Other
No

PART 8 – REMARKS
24

Use this space to:
a) Explain any items that were difficult to classify;
b) Provide additional information concerning any of the entities or other items on the form.

PART 9 – CONTACT INFORMATION
Who should be contacted to answer questions about data reported on this form?

Name of contact person - Please print

§2-6#¤

Area code and phone number

–

–

E-mail Address - Please print

Title of contact person - Please print

Extension

Area code and fax number

–

–

Date form was completed

Thank you for completing this form.
Retain a copy of the completed questionnaire for your records.
NOTE: The U.S. Census Bureau receives its authorization to conduct this survey from Title 13, United States Code, Section 161. This form has been approved by the Office of
Management and Budget (OMB) and given the number 0607-0585. Please note the number displayed 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 was not displayed, under the Paperwork Reduction Act, we could not request your participation in this
voluntary survey. Information provided on this questionnaire compiled from or customarily provided in public records are exempt from confidential treatment as cited in Title 13,
United States Code, Section 9.
Please note that this is a national form that applies to governments with wide differences in the size of their service areas, the amount of population served, and the extent and
complexity of their activities. Public reporting burden for this collection of information is estimated to vary from 1.5 hour to 8 hours per response, with an average of 2.5 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, AMSD-3K138, Washington, DC 20233. You may e-mail comments to [email protected]; use Paperwork Project
0607-0585 as the subject.

Form F-12

17122102

25