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) (07-19-2012) Draft 2

2012 CENSUS OF GOVERNMENTS
SURVEY OF PUBLIC PENSIONS
Supplement to State-Administered Pension Plans
OMB No. 0607-0585: Approval Expires 07/31/2014

DUE DATE:

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

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GENERAL INSTRUCTIONS

1.

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

2.

Report data for the same fiscal year reported on the F-12: State-Administered Defined Benefit Plans form.

3.

Report for Defined Contribution and Postemployment Healthcare plans only.

4.

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 17, REMARKS section, at the end of the form.

5.

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

6.

Report figures relating to all accounts and reserves of the 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.

7.

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

8.

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

Please continue on the next page

17992017

§2ƒ52¤

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

Page 2
PART 1 – PLAN INFORMATION FOR DEFINED CONTRIBUTION PLANS
1

Does this public retirement system offer a defined contribution plan?
Yes – Go to 2
No – Go to 9

2

Are new employees covered under this defined contribution plan?
Yes

3

No

List all defined contribution plans that the retirement system offers below. Report summary data
combining all defined contribution plans.

PART 2 – MEMBERSHIP AND BENEFITS FOR DEFINED CONTRIBUTION PLANS

HOW TO
REPORT
DOLLAR
FIGURES

CORRECT marking example –
Please print all information clearly in ordinary
characters. (Use care to keep characters in their
respective boxes.) To report a negative value,
place the negative symbol inside box.
$Bil.

–

4

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 contributing members of the retirement system during the fiscal year?
Exclude
• Beneficiaries
A. Active members – Current contributors in contributory systems or employees
in non-contributory systems.

Number of
Members

1. Employed by the local government(s)
Include
• Local agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z75DC

Include
• State institutions and agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z76DC

3. TOTAL – (Sum of items A1. through A2.) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z01DC

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.

Number of
Members

1. Vested . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DCM004

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

DCM005

3. TOTAL – (Sum of items B1. through B2.) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Form F-12(S)

Z02DC

Please continue on the next page

17992025

§2ƒ5:¤

2. Employed by the state government

Page 3
PART 3 – RECEIPTS FOR DEFINED CONTRIBUTION PLANS
5

What was the amount of receipts during the fiscal year?
Exclude
• Amounts received from sales of investments
• 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.

$Bil.

Employee Contributions
Mil.
Thou.
Dol.

$Bil.

Employer (Government)
Contributions
Mil.
Thou.
Dol.

1. State employees – From employees of the state
government, including employees of state colleges
and other state institutions and agencies . . . . . . . . . . . . X02DC
2. Local employees – From employees of the counties,
cities, local public schools, and other local
government agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . X01DC
B. Employer (government) contributions – Total amounts
received from state and local governments for financial
support of the system, including any taxes credited
directly to the system.
1. State government contributions
a. State contributions to own system on behalf of
state employees. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z99DC

b. State contributions to own system on behalf of
local employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V87DC

c. TOTAL – (Sum of items B1a. through B1b.) . . . . . . . X06DC
2. Local government contributions – From counties,
cities, local public schools, and other local
government agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . X05DC
C. Earnings on investments
Include
• Interest
• Dividends
• Rents
• Other earnings on investments

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

Z98DC

2. Interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z71DC

3. Dividends
......................................

Z72DC

$Bil.

Investment Earnings
Mil.
Thou.

$Bil.

Mil.

Dol.

4. Other investment earnings – Specify:C
..

5. TOTAL – (Sum of items C1. through C4.) . . . . . . . . . . .

17992033

§2ƒ5B¤

Exclude
• Gains and losses on investment transactions (report
in 6 )

Z73DC

DCR074

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

Form F-12(S)

..

Other Receipts
Thou.

Dol.

Z95DC

Please continue on the next page

Page 4

6

What was the amount of net gains and losses on investments during the fiscal year? Report losses as a
negative value (see HOW TO REPORT DOLLAR FIGURES on Page 2.).
Gains and Losses
$Bil.

A. Realized net gains or losses on investments . .

DCR092

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

DCR094

C. TOTAL – (Sum of items A. through B.) . . . . . .

Mil.

Thou.

Dol.

Payments
Thou.

Dol.

Z96DC/Z91DC

PART 4 – PAYMENTS FOR DEFINED CONTRIBUTION PLANS
7

What was the amount of payments during the fiscal year?
Exclude
• Amounts paid out for purchase of investments and loans made to members
• Deferred retirement option plan (DROP) payments
A. Withdrawals – Amounts paid to employees, former
$Bil.
employees, or their survivors, representing return of
contributions made by employees during the period of
their employment, and any interest on such amounts . . . . . X12DC

Mil.

B. Administrative expenses
Include
• Investment fees
• Other administrative expenses. . . . . . . . . . . . . . . . . . . .

Z93DC

C. Other payments – Specify: C
..

Z90DC

PART 5 – CASH AND INVESTMENTS FOR DEFINED CONTRIBUTION PLANS
8

What was the total amount of cash and investments (at market value) held at the end of the fiscal year?
Exclude
• Receivables and securities lending collateral

$Bil.

Cash and Short-term
Investments
Mil.
Thou.

Dol.

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

Z88DC

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

Z87DC

17992041

§2ƒ5J¤

A. Cash and short-term investments

3. All other short-term investments
Include
• Repurchase agreements
• Commercial company paper
• Finance company paper
• Bankers acceptances
• Money market mutual funds . . . . . . . . . . . . . . X68DC

4. TOTAL – (Sum of items A1. through A3.) . . . . . . X21DC
Continue with 8 on the next page
Form F-12(S)

Please continue on the next page

Page 5

B. Federal government securities
1. Federal treasury securities – Obligations of the
U.S. Treasury and Federal Financing Bank

$Bil.

Include
• Short-term notes. . . . . . . . . . . . . . . . . . . . . .

Federal Government Securities
Mil.
Thou.
Dol.

Z89DC

2. Federal agency
a. Securities – Bonds and mortgage-backed
securities (where applicable) issued by
CCC, Export-Import Bank, FHA, GNMA,
Postal Service, and TVA.
Exclude
• Directly held mortgages (report in
item F.) . . . . . . . . . . . . . . . . . . . . . . . . . . X33DC
b. Federally-sponsored agencies – Bonds
and mortgage-backed securities (where
applicable) issued by FHLB, FHLMC,
FNMA, and Farm credit banks
Exclude
• SLM Corporation (report in item C.) . . . .

Z62DC

3. TOTAL – (Sum of items B1. through B2b.) . . . . . X30DC
C. Corporate bonds, domestic
Include
• Debentures and convertible bonds
• Railroad equipment certificates
• Asset-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.

Z63DC

D. Corporate stocks, domestic

§2ƒ5[¤

E.

Z78DC

Foreign and international securities
Include
• Foreign governments
1. Foreign and international stocks . . . . . . . . . . . .

DCC103

2. Foreign and international bonds . . . . . . . . . . . .

DCC104

3. TOTAL – (Sum of items E1. through E2.) . . . . . .

17992058

Include
• Common and preferred stocks
• Warrants
• Private equity
• Venture capital and leveraged buy-outs
Exclude
• Money market mutual funds (reported in A3.)
• Other mutual funds (report in item H4.)
• Hedge funds (report in item H4.) . . . . . . . . . . . .

Z70DC

8 on the next page
Continue with 4

Form F-12(S)

Please continue on the next page

Page 6

F.

Mortgages held directly
Exclude
• Mortgage-backed securities (reported in
item B2a. or C.)
• Directly held real property (report in item H1.). . X42DC

$Bil.

Mortgages Held Directly
Mil.
Thou.

Dol.

$Bil.

Other Securities
Mil.
Thou.

Dol.

$Bil.

Other Investments
Mil.
Thou.

Dol.

$Bil.

Cash and Investments
Mil.
Thou.

Dol.

G. Investments held in trust by other agencies
Include
• Funds administered by private agencies
• Guaranteed investment accounts
• Share of funds in governmental investment
accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z84DC

H. Other investments
1. Real property – Report only directly held property.
Exclude
• Property held in investment trusts (report in
item H3.)
• Property held in pooled or partnership
agreements (report in item H3.) . . . . . . . . . . X46DC

2. State and local government securities. . . . . . . . . X35DC
3. Other investments
Include
• Property held in pooled or partnership agreements
• Property held in investment trusts
• Investments in REITs
Specify:

. . X47DC

4. Other securities
Include
• Shares held in conditional sales contracts
• Direct loans and loans to members
• Derivatives
• Guaranteed investment contracts
• Annuities and life insurance
• Mutual funds not reported elsewhere
• Hedge funds

Specify:

I.

..

Z83DC

5. TOTAL – (Sum of items H1. through H4.) . . . . . .

Z82DC

TOTAL – (Sum of totals for items A. through H.) . . .

Form F-12(S)

Z81DC

Please continue on the next page

17992066

§2ƒ5c¤

Exclude
• Money market mutual funds (reported in item A3.)

Page 7
PART 6 – PLAN INFORMATION FOR POSTEMPLOYMENT HEALTHCARE PLANS
9

Does this public retirement system offer a postemployment healthcare plan?
Yes – Go to 10
No – Go to 17

10

Are new employees covered under this postemployment healthcare plan?
Yes

11

No

List all postemployment healthcare plans that the retirement system offers below. Report summary data
combining all postemployment healthcare plans.

PART 7 – MEMBERSHIP AND BENEFITS FOR POSTEMPLOYMENT HEALTHCARE PLANS
12

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

Number of
Members

1. Employed by the local government(s)
Include
• Local agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z75HC

2. Employed by the state government
Include
• State institutions and agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z76HC

3. TOTAL – (Sum of items A1. through A2.) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z01HC

Number of
Members

1. Vested . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HCM004

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

HCM005

3. TOTAL – (Sum of items B1. through B2.) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form F-12(S)

Z02HC

Please continue on the next page

17992074

§2ƒ5k¤

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.

Page 8
PART 8 – RECEIPTS FOR POSTEMPLOYMENT HEALTHCARE PLANS
13

What was the amount of receipts during the fiscal year?
Exclude
• Amounts received from sales of investments
• 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.

$Bil.

Employee Contributions
Mil.
Thou.
Dol.

$Bil.

Employer (Government)
Contributions
Mil.
Thou.
Dol.

1. State employees – From employees of the state
government, including employees of state colleges
and other state institutions and agencies . . . . . . . . . . . . X02HC
2. Local employees – From employees of the counties,
cities, local public schools, and other local
government agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . X01HC
B. Employer (government) contributions – Total amounts
received from state and local governments for financial
support of the system, including any taxes credited
directly to the system.
1. State government contributions
a. State contributions to own system on behalf of
state employees. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z99HC

b. State contributions to own system on behalf of
local employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V87HC

c. TOTAL – (Sum of items B1a. through B1b.) . . . . . . . X06HC
2. Local government contributions – From counties,
cities, local public schools, and other local
government agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . X05HC
C. Earnings on investments
Include
• Interest
• Dividends
• Rents
• Other earnings on investments

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

Z98HC

2. Interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z71HC

3. Dividends
......................................

Z72HC

$Bil.

Investment Earnings
Mil.
Thou.

$Bil.

Mil.

Dol.

4. Other investment earnings – Specify:C
..

5. TOTAL – (Sum of items C1. through C4.) . . . . . . . . . . .

17992082

§2ƒ5s¤

Exclude
• Gains and losses on investment transactions (report
in 14 )

Z73HC

HCR074

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

Form F-12(S)

..

Other Receipts
Thou.

Dol.

Z95HC

Please continue on the next page

Page 9

14

What was the amount of net gains and losses on investments during the fiscal year? Report losses as a
negative value (see HOW TO REPORT DOLLAR FIGURES on Page 2.).
Gains and Losses
$Bil.

A. Realized net gains or losses on investments . .

HCR092

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

HCR094

C. TOTAL – (Sum of items A. through B.) . . . . . .

Mil.

Thou.

Dol.

Payments
Thou.

Dol.

Z96HC/Z91HC

PART 9 – PAYMENTS FOR POSTEMPLOYMENT HEALTHCARE PLANS
15

What was the amount of payments during the fiscal year?
Exclude
• Amounts paid out for purchase of investments and loans made to members
• Deferred retirement option plan (DROP) payments
$Bil.

Mil.

A. Healthcare premiums to insurance carriers. . . . . . . . . . Z94HC

B. Claims paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z86HC
C. Administrative expenses
Include
• Investment fees
• Other administrative expenses. . . . . . . . . . . . . . . . . . . .

Z93HC

D. Other payments – Specify: C
..

Z90HC

PART 10 – CASH AND INVESTMENTS FOR POSTEMPLOYMENT HEALTHCARE PLANS
16

What was the total amount of cash and investments (at market value) held at the end of the fiscal year?
Exclude
• Receivables and securities lending collateral

Dol.

A. Cash and short-term investments
1. Cash on hand and demand deposits . . . . . . . . . .

Z88HC

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

Z87HC

17992090

§2ƒ5{¤

$Bil.

Cash and Short-term
Investments
Mil.
Thou.

3. All other short-term investments
Include
• Repurchase agreements
• Commercial company paper
• Finance company paper
• Bankers acceptances
• Money market mutual funds . . . . . . . . . . . . . . X68HC

4. TOTAL – (Sum of items A1. through A3.) . . . . . . X21HC
Continue with 16 on the next page
Form F-12(S)

Please continue on the next page

Page 10

B. Federal government securities
1. Federal treasury securities – Obligations of the
U.S. Treasury and Federal Financing Bank

$Bil.

Include
• Short-term notes. . . . . . . . . . . . . . . . . . . . . .

Federal Government Securities
Mil.
Thou.
Dol.

Z89HC

2. Federal agency
a. Securities – Bonds and mortgage-backed
securities (where applicable) issued by
CCC, Export-Import Bank, FHA, GNMA,
Postal Service, and TVA.
Exclude
• Directly held mortgages (report in
item F.) . . . . . . . . . . . . . . . . . . . . . . . . . . X33HC
b. Federally-sponsored agencies – Bonds
and mortgage-backed securities (where
applicable) issued by FHLB, FHLMC,
FNMA, and Farm credit banks
Exclude
• SLM Corporation (report in item C.) . . . .

Z62HC

3. TOTAL – (Sum of items B1. through B2b.) . . . . . X30HC
C. Corporate bonds, domestic
Include
• Debentures and convertible bonds
• Railroad equipment certificates
• Asset-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.

Z63HC

D. Corporate stocks, domestic

§2ƒ6)¤

E.

Z78HC

Foreign and international securities
Include
• Foreign governments
1. Foreign and international stocks . . . . . . . . . . . .

HCC103

2. Foreign and international bonds . . . . . . . . . . . .

HCC104

3. TOTAL – (Sum of items E1. through E2.) . . . . . .

17992108

Include
• Common and preferred stocks
• Warrants
• Private equity
• Venture capital and leveraged buy-outs
Exclude
• Money market mutual funds (reported in A3.)
• Other mutual funds (report in item H4.)
• Hedge funds (report in item H4.) . . . . . . . . . . . .

Z70HC

4 on the next page
Continue with 16

Form F-12(S)

Please continue on the next page

Page 11

F.

Mortgages held directly
Exclude
• Mortgage-backed securities (reported in
item B2a. or C.)
• Directly held real property (report in item H1.). . X42HC

$Bil.

Mortgages Held Directly
Mil.
Thou.

Dol.

$Bil.

Other Securities
Mil.
Thou.

Dol.

$Bil.

Other Investments
Mil.
Thou.

Dol.

$Bil.

Cash and Investments
Mil.
Thou.

Dol.

G. Investments held in trust by other agencies
Include
• Funds administered by private agencies
• Guaranteed investment accounts
• Share of funds in governmental investment
accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z84HC

H. Other investments
1. Real property – Report only directly held property.
Exclude
• Property held in investment trusts (report in
item H3.)
• Property held in pooled or partnership
agreements (report in item H3.) . . . . . . . . . . X46HC

2. State and local government securities. . . . . . . . . X35HC
3. Other investments
Include
• Property held in pooled or partnership agreements
• Property held in investment trusts
• Investments in REITs
Specify:

. . X47HC

4. Other securities
Include
• Shares held in conditional sales contracts
• Direct loans and loans to members
• Derivatives
• Guaranteed investment contracts
• Annuities and life insurance
• Mutual funds not reported elsewhere
• Hedge funds

Specify:

I.

..

Z83HC

5. TOTAL – (Sum of items H1. through H4.) . . . . . .

Z82HC

TOTAL – (Sum of totals for items A. through H.) . . .

Form F-12(S)

Z81HC

Please continue on the next page

17992116

§2ƒ61¤

Exclude
• Money market mutual funds (reported in item A3.)

Page 12
PART 11 – REMARKS
17

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

Name of contact person – Please print

§2ƒ69¤

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
(MM)
(DD)
(YYYY)

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 2 hours to 8.5 hours per response, with an average of 2 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(S)

17992124

18