Form F-10 (8-10-2015) F-10 (8-10-2015) Quarterly Survey of Public ensions

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

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

QUARTERLY
SURVEY OF PUBLIC PENSIONS

FORM

F-10

(08-10-2015)

OMB No. 0607-0143: Approval Expires xx/xx/xxxx

DUE DATE:

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

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GENERAL INSTRUCTIONS

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 assets relating to all accounts and reserves of the system, INCLUDING amounts for retirement, disability,
survivors’, and other benefits.

4.

PLEASE COMPLETE ALL ITEMS ON THE FORM. If some items do not apply to the system, enter zero ("0") and
specify those items as "not applicable" in 6 , REMARKS. If some items may apply but there is a zero dollar
amount, then do not leave blank. Enter zero ("0").

5.

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

6.

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

1

Is the 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

17105016

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Before filling out this form, please read carefully each part and all related definitions and instructions.
Note especially:
Report figures for the last date of the calendar quarter named in the form title.
1.

ATTN:
Street 1

Street 2

City

State

Zip Code

–
Please continue on the next page

Page 2
PART 1 – RECEIPTS

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.

–
2

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 amount of receipts for each of the following during the quarter ending
Exclude
• Amounts received from sales of investments
• Amounts received from repayment of loans made to members
Contributions
A. Employee contributions – Amounts contributed
by members or withheld from their salaries for
financing of benefits . . . . . . . . . . . . . . . . . . . . . . . .

$Bil.

Mil.

$Bil.

Mil.

Thou.

Dol.

X01/X02

B. Government contributions – Amounts contributed
by administrating state and local governments for
financial support of the system, including any
taxes credited directly to the system . . . . . . . . . . . X04/X06
C. Other government contributions – Any
contributions from another government, not
previously reported in A. or B.
Include
• State aid
• Shared taxes
• Any other amounts received from governments
on behalf of their employees . . . . . . . . . . . . . . . .

X05

D. Interest and dividends – Interest and dividend earnings.
Exclude
• Profits or losses on investments (report in 3 )
Z71

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

Z72

Thou.

Dol.

What was the amount of gains and losses on investments during the quarter ending
Report losses as a negative value (see HOW TO REPORT DOLLAR FIGURES)
Gains and Losses
$Bil.

A. Realized net gains or losses on investments . .

DBR092

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

DBR094

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

Z96/Z91

Form F-10

Mil.

Thou.

Dol.

17105024

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3

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

Earnings

Please continue on the next page

Page 3
PART 2 – PAYMENTS
4

What was the amount of payments made for each of the following during the quarter ending
Exclude
• Amounts paid out for purchase of investments
• Loans made to members
Payments
$Bil.

A. Benefits paid – Retirement, disability, survivor,
and other benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . .

X11

B. Withdrawals – Amounts paid to employees or
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 . . . . . . . . . . . . . . . . . . . . . . . . . .

Z93

Mil.

Thou.

Dol.

PART 3 – CASH AND INVESTMENTS HELD AT END OF QUARTER
5

What was the total amount of cash and investments (at market value) held at the end of the quarter
ending
Exclude
• Receivables

B. Federal government securities
Include
• Obligations of the U.S. Treasury (including
short-term notes) and Federal Financing Bank
• Bonds and mortgage-backed securities (where
applicable) issued by CCC, Export-Import Bank,
FHA, GNMA, Postal Service, and TVA
• Bonds and mortgage-backed securities (where
applicable) issued by FHLB, FHLMC, FNMA, and
Farm credit banks
Exclude
• Directly held mortgages (report in item F.) . . . . . .
C. Corporate bonds, domestic
Include
• Debentures
• Convertible bonds
• Railroad equipment certificates
• Asset-backed securities
• Commercial mortgage-backed securities
• Corporate collateralized mortgage-backed
securities
• Private debt and SLM Corporation
Exclude
• Bonds and mortgage-backed securities (where
applicable) issued by FHLB, FHLMC, FNMA,
and Farm credit banks (reported in item B.) . . . . .

Cash and Short-term Investments
$Bil.

Mil.

Thou.

Dol.

X21

Federal Government Securities
$Bil.

Mil.

Thou.

Dol.

X30

17105032

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A. Cash and short-term investments
Include
• Cash on hand and demand deposits
• Time or savings deposits
• Repurchase agreements
• Commercial company paper
• Finance company paper
• Bankers acceptances
• Money market mutual funds. . . . . . . . . . . . . . . . .

Corporate Bonds
$Bil.

Mil.

Thou.

Dol.

Z77

4 on the next page
Continue with 5

Form F-10

Please continue on the next page

Page 4
PART 3 – CASH AND INVESTMENTS HELD AT END OF QUARTER - Continued
D. Corporate stocks, domestic
Include
• Common and preferred stocks
• Warrants
• Private equity
• Venture capital
• Leveraged buy-outs
Exclude
• Money market mutual funds (reported in item A.)
• Other mutual funds (report in item G2.)
• Hedge funds (report in item G2.) . . . . . . . . . . . . .

E.

F.

Corporate Stocks
$Bil.

Thou.

Dol.

Z78

Foreign and international securities
Include
• Foreign and international bonds
• Foreign and international stocks
• Foreign governments . . . . . . . . . . . . . . . . . . . . . . Z70
Mortgages held directly
Exclude
• Mortgage-backed securities (reported in
item B. or C.)
• Directly held real property (report in item H.) . . .

Mil.

Foreign and International
Securities
$Bil.

Mil.

Thou.

Dol.

Mortgages Held Directly
$Bil.

Mil.

Thou.

Dol.

X42

Other Securities
$Bil.

G. Other securities
1. State and local government securities . . . . . . . . . .

Thou.

Dol.

X35

Z83/Z84

H. Other investments
Include
• Property held in pooled or partnership
agreements
• Investments in REITs
• Property held in investment trusts
• Directly held real property
• Derivatives
• Guaranteed investment contracts
• Annuities
• Life insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z82

Other Investments
$Bil.

Mil.

Thou.

Dol.

Cash and Investments
$Bil.

I.

Form F-10

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

Mil.

Thou.

Dol.

Z81

Please continue on the next page

17105040

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2. Investments held in trust by other agencies and
other securities
Include
• Funds administered by private agencies
• Guaranteed investment accounts
• The share of funds in governmental
investment accounts
• Shares held in conditional sales contracts
• Direct loans
• Loans to members
• Mutual funds not reported elsewhere
• Hedge funds
Exclude
• Money market mutual funds (reported in
item A.) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mil.

Page 5
PART 4 – REMARKS
6

Use this space for any explanations that may be essential in understanding the reported data.
Include
• Any significant changes occurring within the last quarter
• Any difficulties encountered in completing this form
• Provide additional information concerning any of the entities or other items on the form
• Identify and list all items that are "not applicable" for the retirement system

PART 5 – CONTACT INFORMATION
Who should be contacted to answer questions about data reported on this form?

Name of contact person - Please print

Area code and phone number

§2+SZ¤

–

–

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 voluntary survey from Title 13, United States Code, Sections 161 and 182. You are not required to respond
to this collection of information if it does not display a valid approval number from the Office of Management and Budget (OMB). The eight-digit OMB number is 0607-0143 and
appears in the upper right corner of the report form. 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(b).
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 30 minutes to 2 hours per response, with an average of 45 minutes
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: ECON Survey
Comments 0607-0143, U.S. Census Bureau, 4600 Silver Hill Road, EMD-8K122, Washington, DC 20233. You may e-mail comments to [email protected]; use
ECON Survey Comments 0607-0143 as the subject.

Form F-10

17105057

7