Various Government Pretesting Activities

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
FORM

F-11

2012 CENSUS OF GOVERNMENTS
SURVEY OF PUBLIC PENSION PLANS
Locally-Administered Defined Benefit Plans

(07-30-2012)

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

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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 figures for Defined Benefit plans only. Do not include Defined Contribution or other Postemployment
Benefit plans in the 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 16 , 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 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.

6.

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

7.

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

Please continue on the next page

17112012

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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
ATTN:
Street 1

Street 2

City

State

Zip Code

PART 1 – RETIREMENT SYSTEM COVERAGE AND ORGANIZATIONAL INFORMATION
2

Which one of the following best describes the 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 the plan.

B

All members of the 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 separate retirement system fund.

D

Employer and/or employee contributions finance the system. The system is a separate accounting
fund from the administering local government.

PART 2 – PLAN INFORMATION FOR DEFINED BENEFIT PLANS
3

Which one of the following best describes the type of employees to whom active membership in the
retirement system(s) is available? Mark "X" only one box.
Policemen only
Firemen only
Policemen and firemen only

§2,55¤

School employees only – including non-teaching personnel as well as teachers

17112020

Teachers only – instructional staff (including supervisory personnel, but not other school employees)
Other specific group(s)
Specify group(s):
General coverage – All employees (or all regular or full-time employees), subject only to the following
exclusions
Specify exclusions:
4

Are new employees covered under this defined benefit plan?
Yes

Form F-11

No
Please continue on the next page

Page 3

5

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

6

No

In addition to the defined benefit plan reported on this form, does this public retirement system offer
a postemployment healthcare plan?
No

Yes

PART 3 – ENDING DATE OF FISCAL YEAR

(MM)

7

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

8

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

(MM)

(DD)

(DD)

(YYYY)

PART 4 – MEMBERSHIP AND BENEFITS FOR DEFINED BENEFIT 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.

–

9

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
indicated in 8 ?
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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z75

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

Z76

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

DBM004

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

DBM005

3. TOTAL – (Sum of items B1. through B2.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Form F-11

Number of
Members

Z02

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17112038

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2. Employed by the state government

Page 4

10

11

What was the total number of retirees and beneficiaries during the fiscal year indicated in 8 ?
Provide estimates if detailed data are not available.
Number of
Retirees/
Beneficiaries
A. Retirees of system, retired on account of age or service . . . . . . . . . . . . . . . .

Z03

B. Retirees of system, retired on account of disability . . . . . . . . . . . . . . . . . . . .

Z04

C. Survivors of deceased retirees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z05

What were the total number of payees and the amount of lump-sum payments made during the fiscal
year indicated in 8 ?
Number of
Amount Paid
Payees
A. Withdrawals and other
$Bil.
Mil.
Thou.
Dol.
one time payments made
to members of a deferred
retirement option plan
DBM
(DROP) . . . . . . . . . . . . . . . . 010

DBP
010

B. Withdrawals and other one
time payments (other than
loans) made to present or
former members of system
Exclude
• Payment to DROP members
(reported in item A.). . . . . Z06

C. Lump-sum (nonrecurrent)
payments made to survivors
of deceased active members
or retirees. . . . . . . . . . . . . . Z07

PART 5 – RECEIPTS FOR DEFINED BENEFIT PLANS
12

What was the amount of receipts during the fiscal year indicated in 8 ?
Exclude
• Amounts received from sales of investments
• Amounts received from repayment of loans made to members

A. Employee contributions – 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.

X01

1. From parent local government(s)
Include
• Employer contributions from the government for
financing of benefits
• Parent government contributions or appropriations
for administration or other support of the system
• Local taxes credited directly to the system . . . . . . . . .

X04

2. From state government
Include
• State aid
• Shared taxes received by the system from the state
government either directly or through the parent
local government
• Amounts received from other local governments on
behalf of their employees . . . . . . . . . . . . . . . . . . . . . .

X05

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Form F-11

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17112046

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B. Employer (government) contributions

Page 5

C. Earnings on investments
Include
• Interest
• Dividends
• Rents
• Other earnings on investments
Exclude
• Gains and losses on investment transactions (report
in 13 )

1. Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z71

2. Dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Z72

$Bil.

Investment Earnings
Thou.
Mil.

$Bil.

Mil.

Dol.

3. Other investment earnings – Specify:C
...

4. TOTAL – (Sum of items C1. through C3.) . . . . . . . . . . .

Z73

DBR074

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

13

..

Other Receipts
Thou.

Dol.

Z95

What was the amount of net gains and losses on investments during the fiscal year indicated in 8 ?
Report losses as a negative value (see HOW TO REPORT DOLLAR FIGURES on page 3).
Gains and Losses

A. Realized net gains or losses on investments . .

DBR092

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

DBR094

Mil.

Thou.

Dol.

17112053

§2,5V¤

$Bil.

C. TOTAL – (Sum of items A. through B.) . . . . . . . . . . Z96/Z91

Form F-11

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Page 6
PART 6 – PAYMENTS FOR DEFINED BENEFIT PLANS
14

What was the amount of payments during the fiscal year indicated in 8 ?
Exclude
• Amounts paid out for purchase of investments and loans made to members
• Deferred retirement option plan (DROP) payments (reported in 11 )
$Bil.

Mil.

Payments
Thou.

Dol.

A. Benefit payments – Report annual amounts.
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

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

Z93

D. Other payments – Specify:C
..

Z90

PART 7 – CASH AND INVESTMENTS FOR DEFINED BENEFIT PLANS
15

What was the total amount of cash and investments (at market value) held at the end of the fiscal
year indicated in 8 ?
Exclude
• Receivables and securities lending collateral

Dol.

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

Z88

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

Z87

17112061

§2,5^¤

$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. . . . . . . . . . . . . . . .

X68

4. TOTAL – (Sum of items A1. through A3.) . . . . . . .

X21

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Form F-11

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Page 7

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

$Bil.

Federal Government Securities
Mil.
Thou.
Dol.

Include
• Short-term notes . . . . . . . . . . . . . . . . . . . . . . . Z89
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.)

X33

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.) . . . . . .

Z62

3. TOTAL – (Sum of items B1. through B2b.) . . . . . . .

X30

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
• SLM Corporation . . . . . . . . . . . . . . . . . . . . . . . . . .

$Bil.

Corporate Bonds
Mil.
Thou.

Dol.

$Bil.

Corporate Stocks
Mil.
Thou.

Dol.

$Bil.

Foreign and
International Securities
Mil.
Thou.

Dol.

Z63

D. Corporate stocks, domestic
Include
• Common and preferred stocks
• Warrants
• Private equity
• Venture capital
• Leveraged buy-outs

E.

Z78

Foreign and international securities
Include
• Foreign governments

17112079

§2,5p¤

Exclude
• Money market mutual funds (reported in A3.)
• Other mutual funds (report in item H4.)
• Hedge funds (report in item H4.) . . . . . . . . . . . . . .

1. Foreign and international stocks . . . . . . . . . . . . . DBC103

2. Foreign and international bonds . . . . . . . . . . . . . DBC104

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

Z70

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Form F-11

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Page 8

F.

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

$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.

X42

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

Z84

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.) . . . . . . . . . . . . X46

2. State and local government securities . . . . . . . . . .

X35

3. Other investments
Include
• Property held in pooled or partnership agreements
• Property held in investment trusts
• Investments in real estate investment trusts (REITs)
Specify:

..

X47

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

Specify:

I.

Form F-11

..

Z83

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

Z82

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

Z81

Please continue on the next page

17112087

§2,5x¤

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

Page 9
PART 8 – REMARKS
16

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

§2,5¢¤

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 1.5 hours to 8 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-11

17112095

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