Form 10-356A Concessioner Annual Financial Report (For Concessioners

National Park Service Concessions, 36 CFR 51

Form 10-356A Concessioner Annual Financial Report (For Concessioners with Gross Receipts Less than $500,000) 08232016.xlsx

Concessioner Annual Financial Report (For Concessioners with Gross Receipts Less Than $500,000)

OMB: 1024-0029

Document [xlsx]
Download: xlsx | pdf

Overview

Instructions
Concessioner Info
Notices
A
B
C
M1
M2
M3
M4
M5
M6
M7
lookups


Sheet 1: Instructions


INSTRUCTIONS FOR COMPLETING THE ANNUAL FINANCIAL REPORT


1 Enter your financial information in the dark grey cells on each of the following worksheets. Cells not highlighted in dark grey are automatically calculated and should not be changed.


2 Use the tab key or arrow keys to move through the cells in each worksheet.


3 In the "Type of Entity" area on the Concessioner Information worksheet, make the appropriate selection using the dropdown menu.


4 Manually enter the correct concessioner ID. Concessioner ID's take the form ABCD-###, where ABCD represents the alphanumeric code for the park and the numbers are a contract number.


5 To move a comment box, place the cursor on the comment box, left click and hold, then drag the comment box to to another place on the screen.


6 The signature(s) on the Concessioner Info worksheet should be typed rather than written.


7 Do not enter zeroes, NA, dashes or anything else in cells which are not applicable to your operation. Leave these cells blank.


8 For help, email [email protected]

Sheet 2: Concessioner Info

CONCESSIONER: -



PERIOD ENDING: MM/DD/YYYY






For the Period from:
to:








Concessioner ID


Concessioner Name


Park Unit















Contract or Permit Number
Effective Date
Expiration Date






Type of Entity










TABLE OF CONTENTS
Schedule A - Detail of Gross Receipts

Schedule C - Balance Sheet

Schedule B - Income Statement

Schedule M - Operational Statistics







ANNUAL FINANCIAL STATEMENT CERTIFICATION (Either one or both of the certifications below may be completed)










COMPLETE THE CERTICATION BELOW IF YOU ARE THE CONCESSIONER AND COMPLETED THE ANNUAL FINANCIAL REPORT




By typing my name below, I certify that I am authorized to complete and submit this report. This report has been examined by me and to the best of my knowledge and belief is a true, correct, and complete report.


Name of Person Responsible for Report Information


Title


Date






COMPLETE THE CERTIFICATION IF YOU ARE A CPA WHO HAS EITHER COMPILED, REVIEWED OR AUDITED THE CONCESSIONER'S FINANCIAL STATEMENTS AND HAVE COMPLETED THE ANNUAL FINANCIAL REPORT.
By typing my name in the box below, I certify that I have been authorized to complete and submit this report on behalf of the concessioner. This report has been completed and prepared under my supervision using data/information from the company's compiled/reviewed/audited financial statements and/or other financial records and to the best of my knowledge and belief is a true, correct, and complete report.


Name of Person Responsible for Report Information


Title


Date






CONCESSIONER CONTACT INFORMATION






Mailing Address


City


State


Zip Code


Telephone


Email Address






PRORATION OF REVENUES AND/OR EXPENSES







Are expenses and/or revenues prorated as a portion of the entire operation?







If Revenue or Expenses were Prorated, Select Proration Method:






was/were








Proration Percentage








If you prorated revenues/expenses based on another method, please explain below:






Sheet 3: Notices

NOTICES

PRIVACY ACT STATEMENT
Authority: 16 U.S.C. 5966, Commercial Use Authorizations.

Purpose: The purposes of the system are (1) to assist NPS employees in managing the NPS Commercial Services program allowing commercial uses within a unit of the National Park System to ensure that business activities are conducted in a manner that complies with Federal laws and regulations; (2) to monitor resources that are or may be affected by the authorized commercial uses within a unit of the National Park System; (3) to track applicants and holders of commercial use authorizations who are planning to conduct or are conducting business within units of the National Park System; and (4) to provide to the public the description and contact information for businesses that provide services in national parks.

Routine Uses: In addition to those disclosures generally permitted under 5 U.S.C.552a(b) of the Privacy Act, records or information contained in this system may be disclosed outside DOI as a routine use pursuant to 5 U.S.C. 552a(b)(3) to other Federal, state and local governments, tribal organizations, and members of the general public upon request for names, addresses and phone numbers of Commercial Use Authorizations (CUA) holders conducting business within units of the National Park System for the purpose of informing the public of the availability of the services offered by the CUA holder. In addition, records or information contained in this system may be disclosed outside DOI based on an authorized routine use when the disclosure is compatible with the purpose for which the records were compiled as described under the system of records notice for this system.

Disclosure: Voluntary, however, failure to provide the requested information may impede our ability to 1) manage the National Park Service (NPS) Commercial Services Program allowing commercial uses within a unit of the NPS, 2) monitor resources that are or may be affected by the authorized commercial uses, and 3) provide the public the description and contact information for businesses that provide services in national parks.

PAPERWORK REDUCTION ACT STATEMENT
We collect this information under the authority of Title IV of the National Parks Omnibus Management Act of 1998 (Pub. L. 105–391). We use this information to determine the franchise fees of the concessioner. Your response is required to obtain or retain a benefit. We may not collect or sponsor and you are not required to respond to a collection of information unless it displays a currently valid OMB control number. OMB has approved this collection of information and assigned Control No. 1024-0029.

ESTIMATED BURDEN STATEMENT
We estimate that it will take you 4 hours to complete this form, including time to review instructions, gather and maintain data, and complete and review the form. You may send comments on the burden estimate or any aspect of this form to the Information Collection Clearance Officer, National Park Service, 12201 Sunrise Valley Drive, Mail Stop 242, Reston, VA 20192. Please do not send your completed form to this address.

Sheet 4: A


CONCESSIONER: - PERIOD ENDING: MM/DD/YYYY





Amount

LODGING
1 Hotel and Motel
2 Cabins and Cottages
3 Hostels
4 Tent Cabins
5 LODGING DEPARTMENT TOTAL 0




FOOD AND BEVERAGE
6 Restaurant
7 Cafeteria
8 Snack Bar and Fast Food
9 FOOD DEPARTMENT TOTAL 0
10 Alcoholic Beverages




SOUVENIRS
11 Gifts, Curios
12 Genuine Authorized Native Handicrafts
13 SOUVENIR DEPARTMENT TOTAL 0




GENERAL MERCHANDISE
14 Grocery
15 Package Liquor
16 Camera and Photographic Supplies
17 (Other General Merchandise)
18 MERCHANDISE DEPARTMENT TOTAL 0




RECREATION VEHICLE PARKS AND CAMPSITES
19 Tents
20 RV Camping (without hook-ups)
21 RV Camping (with hook-ups)
22 RV Park
23 RV AND CAMPSITES DEPARTMENT TOTAL 0




AUTO SERVICE
24 Fuel and Oil
25 Parts, Service and Other
26 AUTO SERVICE DEPARTMENT TOTAL 0




MARINA
27 Covered Slips
28 Uncovered Slips and Mooring
29 Houseboat Rental
30 Boat and Motor Rental
31 Fuel and Oil
32 Boat and Motor Sales
33 Boat Repair
34 Dry Storage
35 (Other Marina)
36 (Other Marina)
37 MARINA DEPARTMENT TOTAL 0




TRANSPORTATION OF VISITORS
38 Water
39 Air
40 Ground
41 (Other Transportation)
42 (Other Transportation)
43 TRANSPORTATION OF VISITORS DEPARTMENT TOTAL 0




HORSE AND MULE
44 Horse and Mule Pack Services




GUIDED TOURS
45 Float Trips and River Runners
46 Water
47 Ground (Vehicle/Tram/Bus)
48 Ground (Snowmobiles)
49 Air
51 Backcountry Horse Trail Rides
52 Backcountry Hiking
53 (Other Guided Tours)
54 (Other Guided Tours)
55 GUIDED DEPARTMENT TOTAL 0




CRUISE SHIPS
56 Cruise Ships




OTHER
57 Parking Lot
58 Vending Machine
59 Bathhouse/Health Spa Services
60 Rentals (Equipment, Video, Bicycles & Other)
61 Hunting Guides
62 Instructional Service (mountain climbing school; environmental school, etc.)
63 Medical Care
64 Golf Course and Driving Range
65 Sports Facilities
66 (Other Departments)
67 (Other Departments)




EMPLOYEE CHARGES
68 Charges for Employee's meals, lodgings and transportation



69 TOTAL GROSS RECEIPTS 0

Sheet 5: B


CONCESSIONER: - PERIOD ENDING: MM/DD/YYYY





This Period: YYYY

REVENUE AND GROSS PROFIT
1 GROSS RECEIPTS 0
2 SALES RETURNS AND ALLOWANCES
3 NET SALES 0
4 COST OF SALES
5 GROSS PROFIT 0




DIRECT OPERATING EXPENSES
6 Direct Salaries, Wages, Payroll Taxes, and Benefits
7 Commissions
8 Operating Supplies
9 Equipment Rental
10 Contract Services
11 Utilities Expense
12 Licenses and Fees
13 Repair and Maintenance Expense
14 Vehicle Expense
15 Travel and Trip Expense
16 Equipment Purchased
17 Hay, Pasture and Feed
18 (Other Direct Expenses)
19 (Other Direct Expenses)
20 (Other Direct Expenses)
21 TOTAL DIRECT OPERATING EXPENSES 0
22 DEPARTMENTAL INCOME (LOSS) 0




INDIRECT OPERATING EXPENSES
23 Owners, Officers and Partners Salaries, Payroll Taxes and Benefits
24 Other (Administrative) Salaries, Payroll Taxes and Benefits
25 Credit Card Fees
26 Bank Charges
27 Office Expense
28 Dues and Subscriptions
29 Travel Expense
30 Telecommunications Expense
31 Legal Fees
32 Accounting and Audit Fees
33 Advertising and Promotional Expense
34 (Other G&A Expenses)
35 (Other G&A Expenses)
36 TOTAL GENERAL AND ADMINISTRATIVE EXPENSES 0




GOVERNMENT FEES
37 Deductions from Gross Receipts, including Native American Handicrafts
38 Gross Receipts subject to Government Fees 0
39 Percentage of Gross Receipts Fee
40 Flat Fee
41 (Other Government Fees)
42 TOTAL GOVERNMENT FEES AND CONTRIBUTIONS 0



43 TOTAL INDIRECT OPERATING EXPENSES 0
44 TOTAL INCOME (LOSS) FROM OPERATIONS BEFORE FIXED EXPENSES 0







FIXED EXPENSES
45 Rent
46 Property Taxes
47 Business/Liability/Property Insurance
48 Interest Expense
49 Depreciation
50 Amortization
51 (Other Fixed Expenses)
52 TOTAL FIXED EXPENSES 0
53 INCOME (LOSS) BEFORE INCOME TAXES AND OTHER INCOME (EXPENSES) 0




OTHER EXPENSES (INCOME)
54 Interest and Dividend Income (Negative)
55 Loss (Gain) on Sale of Assets
56 (Additional Other Expenses (Income))
57 TOTAL OTHER EXPENSES (INCOME) 0
58 INCOME (LOSS) BEFORE INCOME TAXES 0




INCOME TAXES
59 Federal
60 State and Local
61 TOTAL INCOME TAXES 0
62 NET INCOME (LOSS) 0

Sheet 6: C


CONCESSIONER: - PERIOD ENDING: MM/DD/YYYY




ASSETS This Period: YYYY

CURRENT ASSETS
1 Cash and Cash Equivalents
2 Inventories - Merchandise
3 Accounts Receivable
4 Notes Receivable
5 Prepaid Expenses
6 (Other Current Assets)
7 TOTAL CURRENT ASSETS 0

FIXED ASSETS
8 Depreciable Fixed Assets
9 Less: Accumulated Depreciation
10 Net Depreciable Fixed Assets 0
11 TOTAL FIXED ASSETS 0
12 Net Intangible Assets
13 (Other Assets)
14 TOTAL OTHER ASSETS 0
15 TOTAL ASSETS 0




LIABILITIES

CURRENT LIABILITIES
16 Notes Payable
17 Accounts Payable
18 Current Maturities on Long - Term Debt
19 Government Fees Payable
20 Accrued Liabilities
21 Advance Deposits
22 (Other Current Liabilities)
23 TOTAL CURRENT LIABILITIES 0

LONG-TERM LIABILITIES
24 Long -Term Debt, Excluding Current Maturities
25 (Other Long-Term Liabilities)
26 TOTAL LONG-TERM LIABILITIES 0
27 TOTAL LIABILITIES 0




EQUITY
28 Partner’s or Proprietor’s Capital
29 Common and Preferred Stock
30 (Other Equity)
31 Additional Paid - In Capital
32 Less: Treasury Stock
33 Retained Earnings
34 TOTAL EQUITY 0
35 TOTAL LIABILITIES AND EQUITY 0

Sheet 7: M1


CONCESSIONER: -

PERIOD ENDING: MM/DD/YYYY






Site:



Period Covered:








LODGING


1 Number of Rooms in Facility


2 Total Number of Room Nights Available


3 Total Number of Room Nights Occupied


4 Occupancy Percentage 0%

5 Average Daily Room Rate (ADR)


6 Revenue Per Available Room (RevPAR) 0

7 Total Number of Guests


8 Number of Lodging Employees








FOOD AND BEVERAGE


9 Number of Seats


10 Total Square Feet of Seating Area


11 Total Customers


12 Average Check per Customer


13 Number of Food and Beverage Employees








GIFTS AND MERCHANDISE


14 Total Retail Square Feet (including storage)


15 Average Transaction / square foot


16 Total Number of Retail Employees








MARINAS Number Available Average Occupied Occupancy Rate
17 Covered Slips

0%
18 Uncovered Slips

0%
19 Rental Boats and Houseboats

0%
20 Dry Storage Units

0%
21 Linear Feet of Wet Moorage


22 Number of Marina Employees








TRANSPORTATION / TOUR / GUIDE SERVICE Annual Trips Annual Riders Riders per Trip
23 (Type of Trip/Tour)

0
24 (Type of Trip/Tour)

0
25 (Type of Trip/Tour)

0
26 (Type of Trip/Tour)

0
27 (Type of Trip/Tour)

0
28 Number of Transportation Employees








CAMPGROUNDS Number Available Average Occupied Occupancy Rate
29 Campground Sites

0%
30 Number of Campground Employees








CONCESSION EMPLOYEES Annual

31 Permanent year around employees


32 Filled seasonal positions


33 Estimated total full-time equivalents (One FTE = 2,080 hours)








CONCESSION EMPLOYEE HOUSING Number Available Average Occupied Occupancy Rate
34 Employee Beds

0%


Total Per Occupied Bed
35 Direct Housing Expense
0.00

Sheet 8: M2


CONCESSIONER: -

PERIOD ENDING: MM/DD/YYYY






Site:



Period Covered:








LODGING


1 Number of Rooms in Facility


2 Total Number of Room Nights Available


3 Total Number of Room Nights Occupied


4 Occupancy Percentage 0%

5 Average Daily Room Rate (ADR)


6 Revenue Per Available Room (RevPAR) 0

7 Total Number of Guests


8 Number of Lodging Employees








FOOD AND BEVERAGE


9 Number of Seats


10 Total Square Feet of Seating Area


11 Total Customers


12 Average Check per Customer


13 Number of Food and Beverage Employees








GIFTS AND MERCHANDISE


14 Total Retail Square Feet (including storage)


15 Average Transaction / square foot


16 Total Number of Retail Employees








MARINAS Number Available Average Occupied Occupancy Rate
17 Covered Slips

0%
18 Uncovered Slips

0%
19 Rental Boats and Houseboats

0%
20 Dry Storage Units

0%
21 Linear Feet of Wet Moorage


22 Number of Marina Employees








TRANSPORTATION / TOUR / GUIDE SERVICE Annual Trips Annual Riders Riders per Trip
23 (Type of Trip/Tour)

0
24 (Type of Trip/Tour)

0
25 (Type of Trip/Tour)

0
26 (Type of Trip/Tour)

0
27 (Type of Trip/Tour)

0
28 Number of Transportation Employees








CAMPGROUNDS Number Available Average Occupied Occupancy Rate
29 Campground Sites

0%
30 Number of Campground Employees



Sheet 9: M3


CONCESSIONER: -

PERIOD ENDING: MM/DD/YYYY






Site:



Period Covered:








LODGING


1 Number of Rooms in Facility


2 Total Number of Room Nights Available


3 Total Number of Room Nights Occupied


4 Occupancy Percentage 0%

5 Average Daily Room Rate (ADR)


6 Revenue Per Available Room (RevPAR) 0

7 Total Number of Guests


8 Number of Lodging Employees








FOOD AND BEVERAGE


9 Number of Seats


10 Total Square Feet of Seating Area


11 Total Customers


12 Average Check per Customer


13 Number of Food and Beverage Employees








GIFTS AND MERCHANDISE


14 Total Retail Square Feet (including storage)


15 Average Transaction / square foot


16 Total Number of Retail Employees








MARINAS Number Available Average Occupied Occupancy Rate
17 Covered Slips

0%
18 Uncovered Slips

0%
19 Rental Boats and Houseboats

0%
20 Dry Storage Units

0%
21 Linear Feet of Wet Moorage


22 Number of Marina Employees








TRANSPORTATION / TOUR / GUIDE SERVICE Annual Trips Annual Riders Riders per Trip
23 (Type of Trip/Tour)

0
24 (Type of Trip/Tour)

0
25 (Type of Trip/Tour)

0
26 (Type of Trip/Tour)

0
27 (Type of Trip/Tour)

0
28 Number of Transportation Employees








CAMPGROUNDS Number Available Average Occupied Occupancy Rate
29 Campground Sites

0%
30 Number of Campground Employees



Sheet 10: M4


CONCESSIONER: -

PERIOD ENDING: MM/DD/YYYY






Site:



Period Covered:








LODGING


1 Number of Rooms in Facility


2 Total Number of Room Nights Available


3 Total Number of Room Nights Occupied


4 Occupancy Percentage 0%

5 Average Daily Room Rate (ADR)


6 Revenue Per Available Room (RevPAR) 0

7 Total Number of Guests


8 Number of Lodging Employees








FOOD AND BEVERAGE


9 Number of Seats


10 Total Square Feet of Seating Area


11 Total Customers


12 Average Check per Customer


13 Number of Food and Beverage Employees








GIFTS AND MERCHANDISE


14 Total Retail Square Feet (including storage)


15 Average Transaction / square foot


16 Total Number of Retail Employees








MARINAS Number Available Average Occupied Occupancy Rate
17 Covered Slips

0%
18 Uncovered Slips

0%
19 Rental Boats and Houseboats

0%
20 Dry Storage Units

0%
21 Linear Feet of Wet Moorage


22 Number of Marina Employees








TRANSPORTATION / TOUR / GUIDE SERVICE Annual Trips Annual Riders Riders per Trip
23 (Type of Trip/Tour)

0
24 (Type of Trip/Tour)

0
25 (Type of Trip/Tour)

0
26 (Type of Trip/Tour)

0
27 (Type of Trip/Tour)

0
28 Number of Transportation Employees








CAMPGROUNDS Number Available Average Occupied Occupancy Rate
29 Campground Sites

0%
30 Number of Campground Employees



Sheet 11: M5


CONCESSIONER: -

PERIOD ENDING: MM/DD/YYYY






Site:



Period Covered:








LODGING


1 Number of Rooms in Facility


2 Total Number of Room Nights Available


3 Total Number of Room Nights Occupied


4 Occupancy Percentage 0%

5 Average Daily Room Rate (ADR)


6 Revenue Per Available Room (RevPAR) 0

7 Total Number of Guests


8 Number of Lodging Employees








FOOD AND BEVERAGE


9 Number of Seats


10 Total Square Feet of Seating Area


11 Total Customers


12 Average Check per Customer


13 Number of Food and Beverage Employees








GIFTS AND MERCHANDISE


14 Total Retail Square Feet (including storage)


15 Average Transaction / square foot


16 Total Number of Retail Employees








MARINAS Number Available Average Occupied Occupancy Rate
17 Covered Slips

0%
18 Uncovered Slips

0%
19 Rental Boats and Houseboats

0%
20 Dry Storage Units

0%
21 Linear Feet of Wet Moorage


22 Number of Marina Employees








TRANSPORTATION / TOUR / GUIDE SERVICE Annual Trips Annual Riders Riders per Trip
23 (Type of Trip/Tour)

0
24 (Type of Trip/Tour)

0
25 (Type of Trip/Tour)

0
26 (Type of Trip/Tour)

0
27 (Type of Trip/Tour)

0
28 Number of Transportation Employees








CAMPGROUNDS Number Available Average Occupied Occupancy Rate
29 Campground Sites

0%
30 Number of Campground Employees



Sheet 12: M6


CONCESSIONER: -

PERIOD ENDING: MM/DD/YYYY






Site:



Period Covered:








LODGING


1 Number of Rooms in Facility


2 Total Number of Room Nights Available


3 Total Number of Room Nights Occupied


4 Occupancy Percentage 0%

5 Average Daily Room Rate (ADR)


6 Revenue Per Available Room (RevPAR) 0

7 Total Number of Guests


8 Number of Lodging Employees








FOOD AND BEVERAGE


9 Number of Seats


10 Total Square Feet of Seating Area


11 Total Customers


12 Average Check per Customer


13 Number of Food and Beverage Employees








GIFTS AND MERCHANDISE


14 Total Retail Square Feet (including storage)


15 Average Transaction / square foot


16 Total Number of Retail Employees








MARINAS Number Available Average Occupied Occupancy Rate
17 Covered Slips

0%
18 Uncovered Slips

0%
19 Rental Boats and Houseboats

0%
20 Dry Storage Units

0%
21 Linear Feet of Wet Moorage


22 Number of Marina Employees








TRANSPORTATION / TOUR / GUIDE SERVICE Annual Trips Annual Riders Riders per Trip
23 (Type of Trip/Tour)

0
24 (Type of Trip/Tour)

0
25 (Type of Trip/Tour)

0
26 (Type of Trip/Tour)

0
27 (Type of Trip/Tour)

0
28 Number of Transportation Employees








CAMPGROUNDS Number Available Average Occupied Occupancy Rate
29 Campground Sites

0%
30 Number of Campground Employees



Sheet 13: M7


CONCESSIONER: -

PERIOD ENDING: MM/DD/YYYY






Site:



Period Covered:








LODGING


1 Number of Rooms in Facility


2 Total Number of Room Nights Available


3 Total Number of Room Nights Occupied


4 Occupancy Percentage 0%

5 Average Daily Room Rate (ADR)


6 Revenue Per Available Room (RevPAR) 0

7 Total Number of Guests


8 Number of Lodging Employees








FOOD AND BEVERAGE


9 Number of Seats


10 Total Square Feet of Seating Area


11 Total Customers


12 Average Check per Customer


13 Number of Food and Beverage Employees








GIFTS AND MERCHANDISE


14 Total Retail Square Feet (including storage)


15 Average Transaction / square foot


16 Total Number of Retail Employees








MARINAS Number Available Average Occupied Occupancy Rate
17 Covered Slips

0%
18 Uncovered Slips

0%
19 Rental Boats and Houseboats

0%
20 Dry Storage Units

0%
21 Linear Feet of Wet Moorage


22 Number of Marina Employees








TRANSPORTATION / TOUR / GUIDE SERVICE Annual Trips Annual Riders Riders per Trip
23 (Type of Trip/Tour)

0
24 (Type of Trip/Tour)

0
25 (Type of Trip/Tour)

0
26 (Type of Trip/Tour)

0
27 (Type of Trip/Tour)

0
28 Number of Transportation Employees








CAMPGROUNDS Number Available Average Occupied Occupancy Rate
29 Campground Sites

0%
30 Number of Campground Employees



Sheet 14: lookups

Concessioner Info, Type of Entity Concessioner Info, Proration Concessioner Info, Proration Items Concessioner Info, Proration Methods
Corporation Yes Revenue prorated based on percentage of sales incurred in the park
S Corporation No Expenses prorated based on time spent in the park
B Corporation
Revenue and Expenses prorated based on miles traveled in the park
Limited Liability Company


Partnership


Sole Proprietorship


Other


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