Form 10-355A Business Organization Information (Corporation, Limited

NPS Form 10-355A (Rev. 07/2024)
National Park Service

OMB Control No. 1024-0233
Expiration Date: XX/XX/XXX

OFFEROR FINANCIAL STATEMENTS AND PROJECTIONS
SIMPLE Leases
PROPOSAL PACKAGE
L-XXXX000-YY
Financial Statements
Provide the appropriate financial statements as described below:
The Service needs this information to verify the applicant’s financial capability to carry out the terms of the lease. If the applicant’s total
debts exceed current assets, provide a narrative explaining how these debts will be paid.
Financial statements include both an income statement and a balance sheet. An income statement lists all your income and expenses as
of the last day of your most recent fiscal year. A balance sheet lists everything that you own and everything that you owe as of a certain
date.
If the proposed lessee is not yet in existence as a legal entity or was formed recently and has no financial history, the individual(s) or
entity(ies) that have or will establish the proposed lessee (hereinafter “guarantor(s)”) should submit the appropriate financial statements as
set forth below.
The Service requires all business entities to submit business financial statements.
Provide, at a minimum, an audited or reviewed (i) income statement for the two most recent fiscal years and (ii) balance sheets (1) for the
most recent fiscal year and (2) as of the end of the most recent month prior to the submission of your proposal. Business financial
statements should reflect the entity’s business as a whole, including all operations both inside and outside of the park area.
If a business entity does not have audited or reviewed financial statements, complete the Most Recent Fiscal Year Balance Sheet (Table
1), the Most Recent Month Balance Sheet (Table 2), and the Historical Income Statement (Table 3) provided below.
The Service requires individuals and sole proprietors to submit personal financial statements.
Complete the Personal Financial Statement (Table 4) below.

Page 1 of 12

NPS Form 10-355A (Rev. 07/2024)
National Park Service

OMB Control No. 1024-0233
Expiration Date: XX/XX/XXX

Table 1: Business Financial Statement - Most Recent Fiscal Year Balance Sheet
For Fiscal Year Ending:
Business Financial Statement- Most Recent Fiscal Year Balance Sheet
1

Cash in Bank

$

2

Accounts Receivable

$

3

Inventory

$

4

Other Current Assets (Describe)

$

5

Total Current Assets (add lines 1-4)

$

6

Personal Property (Equipment) Items

$

7

Other Fixed Assets (Describe)

$

8

(LESS Accumulated Depreciation)

$

9

Total Fixed Assets (add lines 6-7, minus line 8)

$

10

Total Assets (add lines 5 & 9)

$

11

Accounts Payable

$

12

Bank Loans Outstanding

$

13

Loans due to Owners

$

14

Other Current Liabilities (Describe)

$

15

Total Current Liabilities (add lines 11-14)

16

Long-Term Liabilities (Describe)

$

17

Total Liabilities (add lines 15 and 16)

$

18

Total Net Worth (line 10 minus line 17)

$

Describe the information in lines 4, 7, 14 & 16 below:

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NPS Form 10-355A (Rev. 07/2024)
National Park Service

OMB Control No. 1024-0233
Expiration Date: XX/XX/XXX

Table 2: Business Financial Statement - Most Recent Month Balance Sheet
For Month Ending:
Business Financial Statement- Most Recent Month Balance Sheet
1

Cash in Bank

$

2

Accounts Receivable

$

3

Inventory

$

4

Other Current Assets (Describe)

$

5

Total Current Assets (add lines 1-4)

$

6

Personal Property (Equipment) Items

$

7

Other Fixed Assets (Describe)

$

8

(LESS Accumulated Depreciation)

$

9

Total Fixed Assets (add lines 6-7, minus line 8)

$

10

Total Assets (add lines 5 & 9)

$

11

Accounts Payable

$

12

Bank Loans Outstanding

$

13

Loans due to Owners

$

14

Other Current Liabilities (Describe)

$

15

Total Current Liabilities (add lines 11-14)

16

Long-Term Liabilities (Describe)

$

17

Total Liabilities (add lines 15 and 16)

$

18

Total Net Worth (line 10 minus line 17)

$

Describe the information in lines 4, 7, 14 & 16 below:

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NPS Form 10-355A (Rev. 07/2024)
National Park Service

Table 3: Business Financial Statement - Historical Income Statement

OMB Control No. 1024-0233
Expiration Date: XX/XX/XXX

Historical Income Statement

1
1a
1b
1c
1d
2
3
4
5
6
6a
6b
6c
6d
6e
6f
7

Some lines may not be used, place "N/A" in these lines.
Include revenues and expenses related to the business as a whole,
including any operations both inside and outside of the park area.
Year 1

Revenues
Revenue Source 1
Revenue Source 2
Revenue Source 3
Revenue Source 4
Total Revenues (add lines 1a-1d)
Cost of Goods Sold
Total Cost of Goods Sold
Gross Profit (line 2 minus line 4)
Direct Expenses
Salaries and Wages
Payroll Taxes and Benefits
Operating Supplies
Car and Truck Expenses
Other Direct Expense 1
Other Direct Expense 2
Total Direct Expenses (add lines 6a-6f)
Undistributed Expenses
8a
Administrative and General
8b
Marketing (Advertising)
8c
Utilities
8d
Repair and Maintenance
8e
Other Undistributed Expense 1
8f
Other Undistributed Expense 2
9
Total Undistributed Expenses (add lines 8a-8f)
10 Fixed Expenses
10a Insurance
10b Rent to NPS (if applicable)
10c Other Fixed Expense 1
10d Other Fixed Expense 2
11 Total Fixed Expenses (add lines 10a – 10d)
Total direct, undistributed and fixed expenses (add lines 7, 9 and
12 11)
13 EBITDA* (Line 5 minus line 12)
14 Depreciation and Amortization
15 Interest
Net Income Before Income Taxes
16
(Line 13, minus lines 14 & 15)
*Earnings before interest, taxes, depreciation and amortization

Year 2

$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$

$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$

$
$
$
$
$
$
$

$
$
$
$
$
$
$

$
$
$
$
$

$
$
$
$
$
$

$
$
$
$

$
$
$

$

$

Page 4 of 12

NPS Form 10-355A (Rev. 07/2024)
National Park Service

OMB Control No. 1024-0233
Expiration Date: XX/XX/XXX

Table 4: Personal Financial Statement
Personal Financial Statement
Name:
As of Date:
% Ownership:
1

Cash in Bank

$

2

IRA and Other Retirement Accounts

$

3

Stocks & Bonds in Taxable Accounts

$

4

Real Estate

$

5

Accounts and Loans Receivable

$

6

Life Insurance (Cash Surrender Value Only)

$

7

Automobile (Present Value Only)

$

8

Other Personal Assets (Describe)

$

9

Total Assets (add lines 1-8)

$

10

Accounts Payable

$

11

Bank Loans Outstanding

$

12

Mortgage Loans Outstanding

$

13

Other Loans Outstanding (Describe)

$

14

Unpaid Tax Liability

$

15

Other Liabilities (Describe)

$

16

Total Liabilities (add lines 10-14)

$

17

Total Net Worth (subtract line 16 from line 9)

$

18

Salary

$

19

Investment Income

$

20

Other Income (Describe)

$

21

Total Income (add lines 18-20)

$

22

Endorsements or Guarantees

$

23

Other Contingent Liabilities (Describe)

$

24

Total Contingent Liabilities (add lines 22-23)

$

Describe the information in lines 8, 13, 15, 20 & 23 below:

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NPS Form 10-355A (Rev. 07/2024)
National Park Service

OMB Control No. 1024-0233
Expiration Date: XX/XX/XXX

Personal Property
Using Table 5 below, list all currently owned personal property with monetary value equal to or exceeding [Insert $ amount] that you will
use for your operations inside of the park area and provide an estimate of its current value. Do not include any personal property for
your operations outside of the park area.
Using Table 5 below, list all the personal property with monetary value equal to or exceeding [Insert $ amount] that you intend to
acquire to use for this lease.
Table 5: Personal Property to be used in association with the Draft Lease

Personal Property

$
$
$
$
$

Total Value of Currently Owned Personal Property
Personal Property

Total Value of Personal Property Investment

Value of Currently Owned
Personal Property

Quantity

Quantity

Value of Personal
Property that will be Acquired
Prior to Operation
$
$
$
$
$

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NPS Form 10-355A (Rev. 07/2024)
National Park Service

OMB Control No. 1024-0233
Expiration Date: XX/XX/XXX

Start-Up Costs
Estimate the start-up costs needed to begin operating the business (within the park area only) and use those estimates to complete the
Table 6 below. Only provide estimates for those items you need to acquire in order to begin operating. Do not include costs for items you
already own. For working capital (cash), estimate the amount of cash you will need to have available after purchasing the other items
(describe) in order to begin operating the business. For example, working capital would include salaries and rent you will pay before you
generate income from the operations in the park area.
The total “Value of Personal Property Investment that will be Acquired Prior to Operation” that you listed in the previous table should be
equal to the amount you list for Personal Property (Equipment) in this table.
Table 6: Start-Up Costs
Estimate of Investment Required to Begin Operations in the Draft Lease
Acquisition/Investment Category
Acquisition/Investment Amount
Personal Property (Equipment)

$

Merchandise (Inventory)

$

Supplies

$

Working Capital (Cash)

$

Other (Describe)

$

Total Funds Needed

$

Describe “Other” investment listed in the table:

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NPS Form 10-355A (Rev. 07/2024)
National Park Service

OMB Control No. 1024-0233
Expiration Date: XX/XX/XXX

Operating Projections
a)

Based on the condition of your personal property provided or purchased for the operation, attach a list of items using Table 7, that
you will need to replace during the term of the lease. Include the anticipated year for the expenditure, the quantity of item(s) to be
replaced, the description of the item(s), the approximate total value of the replacement, and how you plan to pay for the personal
property replacement. (For example, cash, bank loan, etc.).

•

If your projected expenditures for personal property investments exceeds [Insert $ amount], provide an explanation of
how you will fund the investment.

•

If you will not need to replace personal property during the term of the lease, explain your reasoning. Add or remove rows
for years as needed in Table 7.
Table 7: Additional Personal Property Investments

Anticipated Year
of Expenditure

Quantity

Capitalized Personal Property (Equipment) Items

Total Value

How will you fund
the investment?

Year 1
Year 1
Year 2
Year 2
Year 3
Year 3
Year 4
Year 4
Year 5
Year 5
Year 6
Year 6
Year 7
Year 7
Year 8
Year 8
Year 9
Year 9
Year 10
Year 11
b)

Demonstrate that your proposal is financially feasible by completing the following Prospective Income Statement, Table 8.
•

Estimate the amount of income and expenses for the proposed operation for the first year of operation. We included
blank lines on the prospective income statement for your estimates for expense categories we did not list. Describe those
categories on the blank lines.

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NPS Form 10-355A (Rev. 07/2024)
National Park Service

OMB Control No. 1024-0233
Expiration Date: XX/XX/XXX

•

Include only revenues and expenses related to the uses authorized by the Draft Lease inside the park area. Do not
include other services you may provide outside the park area.

•

Fully explain the assumptions on which you base your projections and provide sufficient details so we fully understand
your assumptions. Provide revenue estimates by department, if applicable. If the projections show significantly increased
revenues from the projections provided in your response to the solicitation for the lease, provide a full explanation of the
changes.

Note to Offeror: If you are not familiar with making these types of projections, you should consult an accountant or business
advisor.
Additional instructions for completing the Prospective Income Statement on the next page:
Line 1:
Line 8a:
Line 10a:
Line 13:

If applicable, show revenues by departments (separate revenue activities - e.g., guide services, gift sales, snack bar revenue, etc.).
Administrative and General includes the costs of managing the business and may include items such as: credit card commissions;
legal and accounting fees; travel; meals and entertainment; postage and printing; professional training; telecommunications
expenses; etc.
Insurance: As required in Exhibit [ ] of the Draft Lease
Earnings before interest, taxes, depreciation and amortization

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NPS Form 10-355A (Rev. 07/2024)
National Park Service

OMB Control No. 1024-0233
Expiration Date: XX/XX/XXX

Table 8: Prospective Income Statement
Prospective Income Statement

If a line is marked with an asterisk, see additional notes on the previous page.
Some lines may not be used; place “N/A” in these lines.
Include only revenues and expenses related to the uses authorized by the Draft Lease inside the park area in your prospective
income statement.
Do not include other services you provide outside the park area. This is unlike the income statement you provided in your financial
statements.

2
3
4
5

7

1
1a
1b
1c
1d

6
6a
6b
6c
6d
6e
6f
8
8a
8b
8c
8d
8e
8f

9
10
10a
10b
10c
10d
11
12
13
14
15
16

Revenues*
Revenue Source 1
Revenue Source 2
Revenue Source 3
Revenue Source 4
Total Revenues (add lines 1a-1d)
Cost of Sales
Total Cost of Sales
Gross Profit (Line 2 minus line 4)
Direct Expenses
Salaries and Wages
Payroll Taxes and Benefits
Operating Supplies
Car and Truck Expenses
Other Direct Expense 1
Other Direct Expense 2
Total Direct Expenses (add lines 6a-6f)
Undistributed Expenses
Administrative and General*
Marketing (Advertising)
Utilities
Repair and Maintenance
Other Undistributed Expense 1
Other Undistributed Expense 2
Total Undistributed Expenses (add lines 8a-8f)
Fixed Expenses
Insurance*
Rent to NPS
Other Fixed Expense 1
Other Fixed Expense 2
Total Fixed Expenses (add lines 10a-10d)
Total direct, undistributed, and fixed expenses (add lines 7, 9 and 11)
EBITDA* (Line 5 minus line 12)
Depreciation and Amortization
Interest
Net Income Before Income Taxes
(Line 13, minus lines 14 & 15)

Year 1

Assumptions

$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$

Page 10 of 12

NPS Form 10-355A (Rev. 07/2024)
National Park Service

OMB Control No. 1024-0233
Expiration Date: XX/XX/XXX

NOTICES
PRIVACY ACT STATEMENT
Authority: 54 U.S. Code Chapter 1021—Privileges and Leases; 54 U.S. Code § 306121—Lease or Exchange.
Purpose: The purposes of the system are (1) to assist NPS employees in managing the NPS Leasing program allowing for residential and
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 residential and/or commercial uses
within a unit of the National Park System; (3) to track applicants and holders of leases 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 lease
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 lease 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) Leasing Program allowing for residential and/or commercial uses within a unit of the NPS, 2) monitor resources that are or may be
affected by the authorized residential and/or 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 54 U.S.C. Chapter 1021. We use this information to evaluate a lease proposal. 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. 1024-0233.
ESTIMATED BURDEN STATEMENT
We estimate that it will take no more than 5 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, 13461 Sunrise Valley Drive, Mail Stop 244 Reston, VA 20192. Please do not send
your completed form to this address.

Page 11 of 12