The URL can be used to link to this page

Home My WebLink AboutHandouts_Pension Public Safety_04/18/2006VILLAGE OF TEQUESTA Post Office Box 3273 • 250 Tequesta Drive, Suite 300 Tequesta, Florida 33469-0273 (561) 575-6200 Fax: (561)575-6203 March 15, 2006 Division of Retirement PO Box 3010 Tallahassee, F132315 Re: Annual Report for Year 2005 -Municipal Police Officers and Firefighters Retirement Trust To whom it may concern: is the Annual Report for Year 2005 from the Village of Tequesta regarding the Enclosed Public Safety Officers Pension Board of Trustees. If you have any questions, please feel free to contact me at 575-6244. Sincerely, `~ rte., , Gwen Carlisle, CMC Village Clerk Recycled Paper F[L'.-1\CI_ DF.P.~1'.'I'1,1E~,;`.I. DATE: MARCH 15, 2006 TO: GWEN CARLISLE, VILLAGE CLERK ,PENSION COORDINATOR FROM: JOANN FORSYTHE, FINANCE DIRECTOR RE: 2005 ANNUAL REPORT -PUBLIC SAFETY PENSION TRUST Attached please find the above referenced report that that has been completed with the exception of the signature page that was sent to you last week. We have included an addressed envelope with completed certified mail forms so that you can mail the report as soon as you complete the signature page. Please note this package must be postmarked no later then March 15' ?006 -today. 3/15/0610:06 AM ANNUAL REPORT FOR YEAR 2005 Tequesta (CITY) Police / Firefighter (Public Safety) (NAME OF FUND) 250 Tequesta Drive, PO Box 3273 Tequesta, FL 33969 (ADDRESS OF FUND) STATE OF Florida COUNTY OF Palm Beach We declare that the information given in this Annual Report and any attachments thereto is true and complete to the best of our information, knowledge and belief. We declare that the plan is within the provisions of ss. 175.041 & 185.03, F.S. rf , t, , f C i `-~ Z, ~/~,n1„i' CHAIRMAN Signature Mr. Edward Sabin Please Type: Name of Chairman * Must be member of the Board of Trustees PO Box 3273, Tequesta, FL 33969 Mailing Address 561 575-6200 Esabin@3implant.com Area Code Telephone/Suncom Email .---- {~i °.---=''~ ~~-- SECRETARY S gnature Ray Giblin Please Type: Name of Secretary 357 Tequesta Drive, Tequesta, FL 33469 Mailing Address 561 744-9082 RGiblin@Tequesta.org Area Code Telephone/Suncom Email CONTACT PERSON FOR ANNUAL REPORT: The Municipal Police Officers' and Firefighters' Retirement Trust Funds Office is hereby authorized to contact the person listed above for additional information and/or corrections regarding the annual report. JForsythe@Tequest`~org Email JoAnn Forsythe Name: Please Type Finance Director Title 250 Tequesta Drive, Suite 309 Tequesta, FL 33969 Mailing Address 561 575-6207 Area Code Chairman: Subscrib~.ed~nd sworn to before me this Personally known l!d" or Produced identification ^ :~ t r C ~° Glwn E CsAleb ~` 1 ~ ~' ~ ~ ~ ~"~~ ` C . ~ ` ~ M1' DoimMSSion DD711331 _aT~"' ExPiiss Au{~p125.2008 Secretary: Subscribed d sworn to before me this Personally known or Produced identification ^ Telephone,/^^Suncom ~hday of (~td~.G1 200,, Type of ID /S~day o~~~'~1' 200 ~ Type of ID },,•'-'^~ ~~.. ~....C`~'y,. Gwen E CsrNsh i ` r~ / jMy Gonrrwa.an DDU1331 ~o.~,d` EzgrssAugust25.2008 Revised 11/2005 ( 1 ) 1. BOARD OF TRUSTEES Makeup of Board specified in: Ordinance No. 598, Section 2-61, Dated 06/09/05 Names of Trustees Trustees Elected/Appointed By* Edward Sabin 5th Member Appointee Ray Giblin Elected Member (Fire Rep) Geraldine A Genco Village Council Appointee Ken Nielson Village Council Appointee Jason Fleming Elected Member (Police Rep) * For each Trustee Specify: City Appointee, Police Officer/Firefighter, Elected Fifth Member, or Designated in Ordinance (example: Finance Director, City Clerk or Treasurer). Attach separate page, if necessary. 2. Required Quarterly Board Meetings. List the date (month, day, year) of one Board meeting in each quarter: 1st 11/09/04 2nd 02/18/05 3rd 05/10/05 4th 08/11/05 3. List all ordinances passed during this reporting period that affect your pension fund. An impact statement must be performed for each new ordinance. Any ordinance having no actuarial impact upon the plan must have a letter. from your actuary attesting to this fact. Please indicate whether or not t'he ordinance enacted a benefit improvement that was mandated by Chapter 99-1. If yes, please identify whether the benefit improvement was (a) required minimum benefit or (b) extra benefit. 591 11/18/04 No Impact Ord. Number Date Passed Impact Statement Date 598 06/09/05 03/15/05 Y/N a/b Required by Chapter 99-1? Y/N a/b Required by Chapter 99-1? Y/N a/b . Number Date Pa atement Date Required by Chapter 99-1? Y/N a/b Ord. Number Date Passed Impact Statement Date 9. CHAPTER FUNDS ONLY Required by Chapter 99-1? List any benefit improvements implemented during this reporting period and the date effective: Revised 11/2005 ( 2 ) 1. ACTUARIAL VALUATION Contributions (Page 5, Line 3) for this reporting period were made in accordance with the valuation p erformed by: Gabriel, Roeder, Smith & Company Name of Actuarial Firm J. Stephen Palmquist 301 E Las Olas 81vd,Ste 200 ,Ft. Lauderdale, FL 33301 Contact Person Mailing Address 959 527-1616 Area Code Telephone Number Date of Valuation 10/01/03 Period Covered 10/01/04-09/30/05 2. CERTIFIED PUBLIC ACCOUNTANT Rachlin, Cohen & Holtz, LLP Name of Firm Jerry Chiocca One SE Third Ave, 10th Floor, Miami, FL 33131 Contact Person Mailing Address 305 377-9228 Area Code Telephone Number 3. MONEY MANAGER Rockwood Capitol Name of Firm Andrew Holtgrieve 1401 S Brentwood Blvd Ste 900, St Louis, MO 63199 Contact Person Mailing Address 868 962-8336 Area Code Telephone Number 4. PERFORMANCE EVALUATION Bogdahn Consulting LLC Name of Firm Joe Bogdahn 340 West Central Ave Ste 300, Winter Haven, FL 33880 Contact Person Mailing Address 863 293-8289 Area Code Telephone Number 09/30/05 07/01/05-09/30/05 Date of Evaluation Period Covered 5. LEGAL ADVISOR Hanson, Perry & Jensen, PA Name of Firm Bonni S. Jensen, PA 105 S Narcissus Ave,Ste S10,West Palm Beach, FL 33901 Attorney Mailing Address 561 655-5840 Area Code Telephone/Suncom Number 6. PLAN ADMINISTRATOR Public Safety Officers Pension Board Name of Firm Board of Trustees 250 Tequesta Drive Ste 300, Tequesta, FL 33969 Administrator Mailing Address 561 575-6200 Area Code Telephone/Suncom Number Revised 11/2005 ( 3 2005 Annual Report For The Clty: TEQUESTA MUNICIPAL POLICE OFFICERS' AND FIREFIGHTERS' FUND Please direct all correspondence to: Municipal Police Officers' and Firefighters' Retirement Trust Funds Office Division of Retirement Post Office Box 3010 Tallahassee, Florida 32315-3010 Phone (850) 922-0667 Suncom 292-0667 Fax (850) 921-2161 Web http://www.myflorida.com/frs/mpf Emai 1 mpf@dms.myflorida.com DATE RECEIVED Annual Report Audit Actuarial Valuation APPROVED: Financial Statistical Plan ANNUAL REPORT FOR YEAR 2005 Tequesta (CITY) Police / Firefighter (Public Safety) (NAME OF FUND) 250 Tequesta Drive, PO Box 3273 Tequesta, FL 33469 (ADDRESS OF FUND) STATE OF Florida COUNTY OF Palm Beach We declare that the information given in this Annual Report and any attachments thereto is true and complete to the best of our information, knowledge and belief. We declare that the plan is within the provisions of ss. 175.041 & 185.03, F.S. Signature Mr. Edward Sabin Please Type: Name of Chairman CHAIRMAN * Must be member of the Board of Trustees PO Box 3273, Tequesta, FL 33969 Mailing Address 561 575-6200 Esabin@3implant.com Area Code Telephone/Suncom Email SECRETARY Signature Ray Giblin Please Type: Name of Secretary 357 Tequesta Drive, Tequesta, FL 33969 Mailing Address 561 744-4082 RGiblin@Tequesta.org Area Code Telephone/Suncom Email CONTACT PERSON FOR ANNUAL REPORT: The Municipal Police Officers' and Firefighters' Retirement Trust Funds Office is hereby authorized to contact the person listed above for additional information and/or corrections regarding the annual report. JForsythe@Tequest.org Email JoAnn Forsythe Name: Please Type Finance Director Title 250 Tequesta Drive, Suite 309 Tequesta, FL 33969 Mailing Address 561 575-6207 Area Code Telephone/Suncom Chairman: Subscribed and sworn to before me this day of 200 Personally known ^ or Produced identification ^ Type of ID Secretary: Subscribed and sworn to before me this day of 200 Personally known ^ or Produced identification ^ Type of ID Raviaed 11/2005 ( 1 ) 1. BOARD OF TRUSTEES Makeup of Board specified in: Ordinance No. 598, Section 2-61, Names of Trustees Edward Sabin Ray Giblin Geraldine A Genco Ken Nielson Jason Fleming Dated 06/09/05 Trustees Elected/Appointed By* 5th Member Appointee Elected Member (Fire Rep) Village Council Appointee Village Council Appointee Elected Member (Police Rep) * For each Trustee Specify: City Appointee, Police Officer/Firefighter, Elected Fifth Member, or Designated in Ordinance (example: Finance Director, City Clerk or Treasurer). Attach separate page, if necessary. 2. Required Quarterly•Board Meetings. List the date (month, day, year) of one Board meeting in each quarter: lst 11/09/04 2nd 02/18/05 3rd 05/10/05 4th 08/11/05 3. List all ordinances passed during this reporting period that affect your pension fund. An impact statement must be performed for each new ordinance. Any ordinance having no actuarial impact upon the plan must have a letter from your actuary attesting to this fact. Please indicate whether or not the ordinance enacted a benefit improvement that was mandated by Chapter 99-1. If yes, please identify whether the benefit improvement was (a) required minimum benefit or (b) extra benefit. 591 11/18/09 Ord. Number 598 Date Passe 06/09/05 Ord. Number Date Passe No Impact Impact Statement Date 03/15/05 Impact Statement Date r Date Passed Impact Statement Date Ord. Number Date Pas 9. CHAPTER FUNDS ONLY Statement Date No N/A Required by Chapter 99-1? No b Required by Chapter 99-1? Y/N a/b Required by Chapter 99-1? Chapter 99-1? List any benefit improvements implemented during this reporting period and the date effective: Revised 11/2005 ( 2 ) 1. ACTUARIAL VALUATION Contributions (Page 5, Line 3) for this reporting period were made in accordance with the valuation performed by: Gabriel Roeder, Smith & Company Name of Actuarial Firm J Stephen Palmquist 301 E Las Olas Blvd, Ste 200 ,Ft. Lauderdale, FL 33301 Contact Person Mailing Address 959 Area Code Date of Valuation 10/01/03 2 3 4 5 6 CERTIFIED PUBLIC ACCOUNTANT Rachlin, Cohen & Holtz, LLP Name of Firm 527-1616 Telephone Number Period Covered 10/01/04-09/30/05 Jerry Chiocca One SE Third Ave, 10~h FToor, Miami, FL 33131 Contact Person Mailing Address 305 377-9228 Area Code Telephone Number MONEY MANAGER Rockwood Capitol Name of Firm Andrew Holtgrieve 1901 S Brentwood Blvd Ste 900, St Louis, MO 63144 Contact Person Mailing Address 8gg 962-8336 Area Code Telephone Number PERFORMANCE EVALUATION Boqdahn Consulting LLC Name of Firm Joe Bogdahn 390 west Central Ave Ste 300, Winter Haven, FL 33880 Contact Person Mailing Address 863 293-8289 Area Code Telephone Number 09/30/05 07/01/05-09/30/05 Date of Evaluation Period Covered LEGAL ADVISOR Hanson, Perry & Jensen, PA Name of Firm Bonni S. Jensen, PA 105 S Narcissus Ave, Ste S10,West Palm Beach, FL 33401 Attorney Mailing Address 561 655-5890 Area Code Telephone/Suncom Number PLAN ADMINISTRATOR Public Safety Officers Pension Board Name of Firm Board of Trustees 250 Tequesta Drive Ste 300, Tequesta, FL 33969 Administrator Mailing Address 561 575-6200 Area Code Telephone/Suncom Number Revised 11/2005 ( 3 Village of Tequesta CITY NAME Police / Firefighters (Public Safety) NAME OF PENSION FUND STATEMENT OF ASSETS AND LIABILITIES AS OF 9/30/2005 Month/Day/Year ASSETS - MARKET VALUE CHECKING AND SAVINGS (From pg. 7) CASH 1 $196,332.29 , . CERTIFICATES OF DEPOSIT (From pg. 7) 2 . SHORT TERM INVESTMENTS (From pg. 7) 3 . OTHER CASH AND EQUIVALENTS (From pg. 8) 4 . BONDS AND BILLS (From pg. 8) S 5 U . . . FEDERAL AGENCY GUARANTEED SECURITIES (From pg. 8) 6 $1,079,657.42 . CORPORATE BONDS (From pg. 8) 7 $55,510.37 . STOCKS (From pg. 9) 8 $1,598,367.51 . OTHER SECURITIES (From pg. 9) 9 . REAL ESTATE (From'pg. 9) 10 . INVESTMENTS HELD BY INSURANCE COMPANY (From pg. 9) 11 . (From pg. 10) 12 . (From pg. 10) 13 . ACCOUNTS RECEIVABLE (From pg. 10) 14 $25,151.61 . ACCRUED INTEREST 15 . 16. TOTAL ASSETS (sum of lines 1-15) $2,900,219.20 LIABILITIES REFUNDS PAYABLE 17 . PENSIONS PAYABLE 18 . UNPAID EXPENSES 19 $2,661.50 . DROP PLAN PAYABLE 20 . 21. Due to General Fund $300.00 22. TOTAL LIABILITIES (sum of lines 17-21) $2,961.50 23. FUND BALANCE (subtract line 22 from line 16) MUST agree with page 5, line 25> $2,897,257.70 Revised 11/2005 ( 9 ) Village of Tequesta CITY NAME Polce / Firefighters (Public Safety) NAME OF PENSION FUND STATEMENT OF REVENUES, EXPENDITURES & CHANGES IN FUND BALANCE FOR THE PERIOD ENDING 9/30/2005 Month/Day/Year REVENUES 1. CONTRIBUTIONS FROM EMPLOYEES (From pg. 14) 2. CONTRIBUTIONS FROM STATE OF FLORIDA (From pg. 6) 3. CONTRIBUTIONS FROM CITY (From pg. 6) 9. CONTRIBUTIONS FROM CITY - FOR EMPLOYEES 5. BUYBACKS/REPAYMENT OF CONTRIBUTIONS 6. Additional Deposit for FY 03/04 7. UNREALIZED GAINS/LOSSES 8. INTEREST AND DIVIDENDS 9. GAIN FROM SALE OF INVESTMENTS 10. TOTAL REVENUE (sum of lines 1-9) T.`YDFTTTITTTTRFC 11. RETIREMENT PENSION PAYMENTS (From pg. 12) 12. DISABILITY PENSION PAYMENTS (From pg. 12) 13. BENEFICIARY PENSION PAYMENTS (From pg. 12) 14. TOTAL PENSION PAYMENTS (sum of lines 11-13) 15. TERMINATION PAYMENTS (From pg. 13) 16. DROP PLAN PAYMENTS 17. INSURANCE PREMIUM PAYMENTS 18. EXPENSES (From pq. 6) 19. 20. 21. LOSS FROM SALE OF INVESTMENTS 22. TOTAL EXPENDITURES (sum of lines 14-21) 23. NET INCREASE / (DECREASE) (subtract line 22 from line 10) 29. FUND BALANCE - BEGINNING OF YEAR:October 1, 2004 <MUST agree with prior year report page 5, line 25> 25. FUND BALANCE - END OF YEAR: September 30, 2005 (line 23 plus line 24) <MUST agree with page 4, line 23> $83,339.33 $158,222.36 $144,635.79 $19,938.06 (5117,819.07) $82,254.53 5202,607.23 $572,678.23 $28,589.53 $3,315.98 537,214.48 $69,119.49 $503,558.79 $2,393,698.96 $2,897,257.70 Raviaed 11/2005 ( 5 ) 1. TOTAL CALENDAR YEAR 2005 POLICE DEPARTMENT PAYROLL: $ 808,135.94 TOTAL CALENDAR YEAR 2005 FIRE DEPARTMENT PAYROLL: $ 1,129,036.73 ** IMPORTANT ** This figure must be on a calendar year basis. Police Department Payroll includes all employees of the Police Department (secretaries, dispatchers, police officers, etc.). Fire Department Payroll includes all employees of the Fire Department EXCEPT for members included in the Florida Retirement System. If lower than last year, or significantly higher, please explain! 2.STATE OF FLORIDA PREMIUM TAX MONEY FIRE Date of Deposit 10/25/09 Amount 12,596.05 POLICE Date of Deposit Amount 09/23/05 65,700.10 09/23/05 63,912.29 Total Fire 592,522.26 Total Police r _ ~ 1 ~ ~ ~• .,, TOTAL (page 5, line 2) 3. CITY CONTRIBUTION Date of Deposit Bi-weekly Amount Date of Deposit $194,635.79 TOTAL CITY CONTRIBUTION (Page 5, Line 3) 4. DETAIL OF EXPENSES ADMINISTRATIVE EXPENSES Item Amount Item Legal Services $7, 539.34 Travel ~ Per Diem Recording Secretary $300.90 Professional Service Other Contractual $1, 008.90 Sub-Total Admin. Expenses INVESTMENT EXPENSES Item Amount Investment Services $22, 795.87 Item $65,700.10 5158,222.36 Amount $194,635.79 Amount $613.47 $4,956.00 $19,418.61 Amount Sub Total -- Investment Expenses Total Expenses (Page 5, Line 18) $22,795.87 $37,214.48 Revised 11/2005 ( 6 ) 1. TOTAL CALENDAR YEAR 2005 POLICE DEPARTMENT PAYROLL: $ 0.00 TOTAL CALENDAR YEAR 2005 FIRE DEPARTMENT PAYROLL: $ 0.00 ** IMPORTANT ** This figure must be on a calendar year basis. Police Department Payroll includes all employees of the Police Department (secretaries, dispatchers, police officers, etc.). Fire Department Payroll includes all employees of the Fire Department EXCEPT for members included in the Florida Retirement System. If lower than last year, or significantly higher, please explain! 2.STATE OF FLORIDA PREMIUM TAX MONEY FIRE Date of Deposit Amount 10/12/05 16,513.97 Total Fire 3. CITY CONTRIBUTION Date of Deposit POLICE Date of Deposit Amount Total Police TOTAL (page 5, line 2) Amount Date of Deposit Amount TOTAL CITY CONTRIBUTION (Page 5, Line 3) 4. DETAIL OF EXPENSES ADMINISTRATIVE EXPENSES Item Amount Item Amount Sub-Total Admin. Expenses INVESTMENT EXPENSES Item Amount Item Amount Sub Total -- Investment Expenses Total Expenses (Page 5, Line 18) Revised 11/2005 ( 6 ) -- Village of Teguesta 2005 ACTUARIAL CONFIRMATION OF THE USE OF STATE MONEYS (LOCAL LAW PLANS ONL }1 TO BE FORWARDED TO THE PLAN ACTUARY FOR COMPLETION AND RETURNED TO THE MUNICIPALITY AS SOON AS POSSIBLE, SO THAT IT MAY BE SUBMITTED TOGETHER WITH THE ANNUAL REPORT DUE ON MARCH 15, 2006. The Plan's actuary must provide the following information in order for the MPF office to detetnune that State premium tax revenues are being used in accordance with the provisions of sections 175.351 and 185.35, Florida Statutes, as amended by Chapter 99-I, Laws of Florida. A. Name of actuarial firm Gabriel Roeder Sinith and Company B. Date of most recent actuarial valuation 10/1/2003 C. Use of State money -- Please provide the following information: (1) Annual cost of qualifying benefit improvements -- required minimum benefit improvements or "extra benefit" improvements -- enacted during the fiscal year. Recurring costs One-time use 1999 - 2004 $ 14,392 (Previously reported) 2005 $ 25,313 $ 7,878 Ordinance Number(s) (Previously reported) 598 (2) For the Fiscal Year 2005, please indicate the amount of State premium tax moneys that are available to be used by the plan sponsor toward the minimum required contributions. (NOTE: If there have been no qualifying benefit improvements since the enactment of Chapter 99-1, Laws of Florida, [his amount can be no more than the 1997 base year amount.) Police $ 33,130 Fire $ 63,412 Fire Supplemental $ 4,638 (3) Are there any remaining minimum benefit improvements required to be made subject to the provisions of Chapter 99-1, Laws of Florida? If yes, please identify. Attach additional page, if necessary. YES NO X (4) As of Fiscal Year End 2005, please provide the cumulative balance of additional premium tax revenues that are remaining to be used to provide future minimum or "extra benefit" improvements. If the sum total of all qualifying benefit improvements enacted since Chapter 99-1 exceeds the total additional premium tax revenues received this year, this may be a negative balance; however, negative balances are not cumulative. NOTE: Investment Earnings, if included, may not be negative in the aggregate. Total Accumulated Balance 9/30/05 (Includes Investment Earnings of $ 105.661 $ 0 ) D. Actuary representing the Plan: Name: J. Stephen Palmquist (Please print) ,, C __ ~ (Signature) F.S. Chapters 175, 175 Supplemental and 185 separately tracked. Revised 11/2005 (6a) Telephone: (954) 527-1616 (Date) INVESTMENTS Police / Firefighters (Public Safety) NAME OF PENSION FUND 1. Ordinance describing the Fund's investment guidelines: Ordinance No. 598 Section 2-61 Date 06/09/05 Has the board adopted a written investment policy in accordance with the requirements of section 112.661, F.S., and submitted a copy of this policy to Charles Slavin's office in the Bureau of Local Retirement Systems? Yes No Has the board prepared a Summary Plan Description in accordance with the requirements of section 112.66, F.S., and submitted a copy of this document to Charles Slavin's office in the Bureau of Local Retirement Systems? Yes No 2. SCHEDULE OF INVESTMENTS AT MARKET VALUE Institution Holding Deposit Amount Interest Rate (1) CASH, Checking & Savings Wachovia Securities $9,123.58 Salem Trust Company $137,208.71 Total $146,332.29 (Page 4, Line 1) (2) CERTIFICATES OF DEPOSIT Total (Page 4, Line 2) (3) SHORT-TERM INVESTMENTS Total (Page 9, Line 3) Revised 11/2005 ( 7 ) 2. SCHEDULE OF INVESTMENTS - continued Institution Holding Deposit Amount Interest Rate (4) OTHER CASH & EQUIVALENTS (5) U. S. BONDS & BILLS Total (Page 9, Line 4) (6) FEDERAL AGENCY GUARANTEED Salem Trust Company Total SECURITIES $1,074,857.42 (Page 4, Line 5) (7) CORPORATE BONDS Salem Trust Company Total $55,510.37 $1,079,857.42 (Page 4, Line 6) Total $55,510.37 (Page 9, Line 7) Aaviaed 11/2005 ( 8 ) 2. SCHEDULE OF INVESTMENTS - continued Institution Holding Deposit Amount Interest Rate (8) STOCKS Salem. Trust Company 51,598,367.51 (9) Total OTHER SECURITIES 51,598 (Page ,367.51 9, Line 8) (10) Total REAL ESTATE (Page 4, Line 9) (11) Total INVESTMENTS HELD BY INSURANCE COMPANY (Page 4, Line 10) Total (Page 4, Line 11) Revised 11/2005 ( 9 ) 2. SCHEDULE OF INVESTMENTS - continued Institution Holding Deposit (12) Amount Interest Rate Total (Page 4, Line 12) (13) Total Page 4, Line 13) (14) ACCOUNTS RECEIVABLE DUE FROM Village of Tequest Village of Tequest State of Florida ** DATE OF PAYMENT 10/07/05 10/07/05 09/28/05 TOTAL ACCOUNTS RECEIVABLE Page 4, Line 19) AMOUNT $8,426.25 $211.39 $16,513.97 $25,151.61 * State of Florida Contribution may NOT be listed as a receivable if the Annual Report was not approved before the plan's fiscal year end. ** Required for all receivables. Revised 11/2005 ( 1 Q ) INSURED PLANS ~~:~+ ~~ TO BE FORWARDED TO INSURANCE COMPANY FOR COMPLETION AND RETURNED TO MUNICIPALITY AS SOON AS POSSIBLE, BUT PRIOR TO FILING DATE OF REPORT, MARCH 15, 2006. A. NAME OF CARRIER: B. TYPE AND CONTRACT NUMBER: C. TYPE AND BASIS OF FUNDING: CURRENT SERVICE: PAST SERVICE: D. NUMBER OF EMPLOYEES COVERED: RETIRED: ' NON-RETIRED: E. DATE OF LAST PLAN AMENDMENT (IF ANY): F. INSURANCE COMPANY REPRESENTATIVE HANDLING REPORT FOR MUNICIPALITY: NAME: TITLE: PHONE NUMBER: I have forwarded to the person completing this report a copy of the contractholder's account statement as of , (date) showing a balance of $ (amount), invested with this company. (Signature) (Date) NOTE: A copy of the contractholder's account statement as of the reporting date of the Annual Report must be submitted with the Annual Report. The statement must show all changes to the reserve account. The contractholder's account statement is required even though pages 4 and 5 are completed by the insurance company., Revised ii/loos ( 1 1 ) IMPORTANT Before completing pages 12, 13, 14 and 15, please read these instructions. Pages 12, 13, 19 and 15, must be completed using the same reporting period as pages 1 through 11. All statistical data on these pages should be based on employment as a certified (or to be certified within one year of employment) op lice officer or firefighter. Complete all columns on each page. The statistical data on this year's report will be compared to the statistical data on last year's report. Please check to be sure that all police officers and firefighters are accounted for and that all dates are correct. The totals on pages 12, 13, 14 and 15, must be the same as the totals on page 5, lines 1, 11, 12, 13, 15, and 16. This page is intentionally not numbered. 2005 Report Number of Retired Police Officers on this Report 0 Police /Firefighters (Public Safety) POLICE OFFICERS' PENSION DATA Reporting Period 10/ O 1/ 04 to 09/ 30/ OS Social Security Number A Name (Please sort alphabetically) Last, First, M[ e Date of Birth ~ Dale of Retire /Disability (Indicate with R / D) n Disability Code * e Name of Beneficiary r Date of Birth of Beneficiary c Pension Option Elected ** x Monthly Pension Received By Retiree or Beneficiary ~ Total Received This Reporting Period i 1 -Heart Disease 2 -Hypertension 3 -Emphysema 4 -Injury 5 -Other (please specify) 6 -Cancer Please indicate LOD /NLOD l -Life & 10 Yrs. Certain 2 -Lifetime of Retiree Only 3 -Joint & Survivor (A) 100°/ (C) 66 2/3% 4 -Other (please specify) 5-DROP Subtotals: Retirement $ - Disability $ - Beneficiary $ - SUBTOTAL: Police Officers' Pension Payments $ - (add to page 12A) (12) 2005 Report Number of Retired Firefighters on this Report 1 Social Security Number A Name (Please sort alphabetically) Last, First, MI tl Date of Birth C Date of Retire /Disability (Indicate with R / D) n Disability Code * E Name of Beneficiary F Date of Birth of Beneficiary C. - Pension Option Elected ** H Monthly Pension Received By Retiree or Beneficiary I Total Received This Reporting Period Campbell, Timothy 10/04/66 2/2/2005 R Vested FIREFIGHTERS' PENSION DATA Police /Firefighter (Public Safety) Reporting Period 10/ O1/ 04 to 09/ 30/ OS 4 1 -Heart Disease 2 -Hypertension 3 -Emphysema 4 -Injury 5 -Other (please specify) 6 -Cancer Please indicate LOD /NLOD ## 1 -Life & 10 Yrs. Certain 2 -Lifetime of Retiree Only 3 -Joint & Survivor (A) 100°/ (C) 66 2/3% (B) 75% (D) 50% 4 -Other (please specify) 5 -DROP Subtotals: Retirement $ - Disability $ - Benefrciary $ - SUBTOTAL: Firefighters' Pension Payments $ - TOTAL: Police & Fire Combined $ - (must agree with page 5, line 14) (12A) 2005 Report Number of Terminated Police Officers on [his Report Police /Firefighters (Public Safety) POLICE OFFICERS' TERMINATIONS Reporting Period 10/ O1/ 04 to 09/ 30/ OS Social Security Number A Name (Please sort alphabetically) Last, First, MI 9 Sex- C Date of Birth O Date of Employment E Date of Termination F Reason Terminated C Amount Refunded at Termination N Meehan, Gregory M 07/17/71 10/01/03 OU23/OS Resigned 3,757.09 Petrick, Joseph M 06/1 ]/71 06/04/01 08/05/05 Resigned 9,367.01 SUBTOTAL: Police Officers' Termination Payments $ 13,124.10 (add to page 13A) (13) 2005 Report Number of Tenninated Firefighters on this Report Police /Firefighters (Public Safety) FIREFIGHTERS' TERMINATIONS Reporting Period 10/ O1/ 04 to 09/ 30/ OS Social Security Number A Name (Please sort alphabetically) .Last, First, MI ~ B Sex C Date of Birth D Date of Employment E Date of Termination f Reason Terminated (: Amount Refunded at Termination H Knapp, Michael M 04/04/80 06/06/00 06/14/05 Resigned 12,877.88 Madera, Roberto M 09/09/72 04/24/0] 08/16/02 Resigned 2,587.55 Nathanson, Alex M 03/19/63 08/02/93 01/03/01 Resigned Not Yet Refunded SUBTOTAL: Firefighters' Termination Payments $ 15,465.43 TOTAL: Police & Fire .Combined $ 28,589.53 (must agree with page 5, line 15) (13A) 2005 Report Police /Firefighters (Public Safety) POLICE OFFICERS' STATISTICAL EXHIBIT Number of Active Police Officers on this Report 14 Reporting Period 10/ Ol/ 04 to 09/ 30/ OS l i S Name Date Dale of Years of Credited Date o(Entry Monthly Salary Total Cash Compensation Amount Contributed to a oc Security Number (Please sort alphabetically) Last, First, MI e of Birth Sex Age r Employment as a Police Officer r Service in Police Retirement Plan into Police Retirement Plan " Used to Compute Pension Contribution Paid During this Reporting Period Fund by Officer During Period (5 % ) Boedell,Chris 04/15/84 M 21 09/06/05 0 09/06/05 3,584.30 4,135.74 206.79 i Cox, John 06/07/59 M 46 01/06/03 3 01/06/03 4,389.28 48,780.72 2,439.04 Crouse, Richard 06/17/68 M 37 03/08/04 2 03/08/04 3,589.54 38,523.28 1.926.16 i Fabianq Jose h 06/23/60 M 45 04/04/05 0 04/04/05 4,250.00 24,519.28 1,225.96 Flemin ,Jason 07!19/74 M 31 10/IS/OI 4 10/15!01 4,040.98 47,780.50 2.389.03 Galli. Matthew 07/03/73 M 32 04/26/03 2 04/26/03 3,865.70 57,936.62 2,896.83 Malley, Charles 09/01/73 M 32 05/06/02 3 05/06/02 4,207.09 42,829.03 2.141.45 McLain-llubbard,Jennifer 12/21/61 F 44 12/18/00 5 12/18/00 4,121.89 55,870.74 2.793.54 Meehan, Gre pry 07/17/71 M 34 10/01/03 2 10/01/03 4,143.28 21,424.67 1.071.23 Morrill, Michael 04/30/53 M 52 09/08/80 0 09/04/05 6,920.16 10,389.02 519.45 Petrick,Jose h 06/1(/71 M 34 06/04/01 4 06/04/01 4,185.58 42,113.50 2.105.68 Smolen, Keith 08/28/72 M 33 02/26/01 5 02/26/01 4,253.70 67,530.51 3,376.53 Turner, Jason 09/15/75 M 30 10/04/98 7 10/04/98 4,630.14 60,761.23 3,038.06 Youn blood, Brian 11/16/67 M 38 Ol/02/02 4 01/02/02 4,584.69 59,787.75 2,989.39 SUBTOTAL: Police Officers' Contributions S 29,119.13 (add to pages 14A & 14B) (ta) 2005 Report Police !Firefighters (Public Safety) FULLTIME FIREFIGHTERS' STATISTICAL EXHIBIT SUBTOTAL: Fulltime Firefighters' Contributions S 54,220.20 (add to page 14B) (14A) Number oCActive Fulltime Firefighters nn this Report 18 Reporting Period 10/ OU 04 to 09/ 30/ OS 2005 Report Number of Active Volunteer Firefighters on this Report Police /Firefighters (Public Safety) VOLUNTEER FIREFIGHTERS' STATISTICAL EXHIBIT Reporting Period 10/ Ol/ 04 to 09/ 30/ OS Social Name Date Date of Years of Credited Date of Entry Monthly Salary Total Cash Compensation Amount Contributed to Security Number (Please sort alphabetically) Last, First, MI of Birth Sex n Age c Employment as a Firefighter r Service in Fire Retirement Plan c into Fire Retirement Plan Used to Compute Pension Contribution ~ Paid During this Reporting Period Fund by Firefighter During Period (_ % ) SUBTOTAL: Volunteer Firefighters' Contributions TOTAL: Police and Fire Combined S 83,339.33 (must agree with page 5, line 1) (146) 2005 Report Number o(Police Officers on this Report Police !Firefighters (Public Safety) POLICE OFFICERS' DROP PLAN PARTICIPANT BALANCE ROLLFORWARD Reporting Period 10/ Ol/ 04 to 09/ 30/ OS Social Security Name (Please sort alphabetically) Date of Date of Employment Date of Entry into DROP Beginning t ' 1 ' ' / ~ Additions Ending Number Last, First, MI Birth N Plan Balance ! Monthly Fiscal Year H Interest Earned / Distributions Balance f.N./-/ Police Subtotals 5 (Carryforward Subtotals to page 15A) E S - S - 3 - (15) 2005 Report Number of Firefighters on this Report Police /Firefighters (Public Safety) FIREFIGHTERS' DROP PLAN PARTICIPANT BALANCE ROLLFORWARD Reporting Pcriod 10/ Ol/ 04 to 09/ 30/ OS Social Security Name (Please sort alphabetically) Date of Date of Employment Date of Entry into DROP Beginning 1 ' 1 ' ~ ~ , Additions Ending Number Last, First, MI B Birth C Plan E Balance Monthly Fiscal Year Interest Earned Distributions Balance A'-f~N•l~l Fire Subtotals S Subtotals from page 15 E TOTALS S - (MUST agree to prior year ending balance page 15) s s - s - s - a - s - s s s - s - s - s - (15A)