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Concessioner Annual Financial Report (For Concessioners with Gross Receipts Less Than $500,000)
ICR 202607-1024-005 · OMB 1024-0029 · Object 171334400.
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| File Type | application/pdf |
|---|---|
| File Title | Concessioner Annual Financial Report (For Concessioners with Gross Receipts Less Than $500,000) |
| File Modified | 2019-12-10 |
| File Created | 2019-11-04 |
| Conversion State | complete |
Extracted Text
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] NPS Form 10-356A (12/2019) National Park Service OMB Control No. 1024-0029 Expiration Date XX/XX/XXXX 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 Schedule A - Detail of Gross Receipts Schedule B - Income Statement TABLE OF CONTENTS Schedule C - Balance Sheet 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: NPS Form 10-356A (Rev. 12/2019) National Park Service OMB Control No. 1024-0029 Expiration Date XX/XX/XXX 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, 1201 Oakridge Drive, Fort Collins, CO 80525. Please do not send your completed form to this address. SCHEDULE A - DETAIL OF GROSS RECEIPTS 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 10 Alcoholic Beverages 0 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 Page 4 SCHEDULE A - DETAIL OF GROSS RECEIPTS CONCESSIONER: - PERIOD ENDING: MM/DD/YYYY Amount 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 Page 5 SCHEDULE B - INCOME STATEMENT CONCESSIONER: - PERIOD ENDING: MM/DD/YYYY This Period: YYYY REVENUE AND GROSS PROFIT 1 GROSS RECEIPTS 2 SALES RETURNS AND ALLOWANCES 3 NET SALES 4 COST OF SALES 5 GROSS PROFIT 0 0 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 22 DEPARTMENTAL INCOME (LOSS) 0 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 39 Percentage of Gross Receipts Fee 40 Flat Fee 41 (Other Government Fees) 42 TOTAL GOVERNMENT FEES AND CONTRIBUTIONS 43 TOTAL INDIRECT OPERATING EXPENSES 44 TOTAL INCOME (LOSS) FROM OPERATIONS BEFORE FIXED EXPENSES FIXED EXPENSES Page 6 0 0 0 0 SCHEDULE B - INCOME STATEMENT CONCESSIONER: - PERIOD ENDING: MM/DD/YYYY This Period: YYYY 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 53 INCOME (LOSS) BEFORE INCOME TAXES AND OTHER INCOME (EXPENSES) 0 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) 58 INCOME (LOSS) BEFORE INCOME TAXES 0 0 INCOME TAXES 59 Federal 60 State and Local 61 TOTAL INCOME TAXES 62 NET INCOME (LOSS) 0 0 Page 7 SCHEDULE C - BALANCE SHEET (For Concessioners with Gross Receipts Between $250,000 and $500,000) CONCESSIONER: PERIOD ENDING: MM/DD/YYYY ASSETS 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 FIXED ASSETS 8 Depreciable Fixed Assets 9 Less: Accumulated Depreciation 10 Net Depreciable Fixed Assets 11 TOTAL FIXED ASSETS 12 Net Intangible Assets 13 (Other Assets) 14 TOTAL OTHER ASSETS 15 TOTAL ASSETS This Period: YYYY 0 0 0 0 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 LONG-TERM LIABILITIES 24 Long -Term Debt, Excluding Current Maturities 25 (Other Long-Term Liabilities) 26 TOTAL LONG-TERM LIABILITIES 27 TOTAL LIABILITIES 0 0 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 35 TOTAL LIABILITIES AND EQUITY 0 0 Page 8 SCHEDULE M1 - OPERATIONAL STATISTICS 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 5 Average Daily Room Rate (ADR) 6 Revenue Per Available Room (RevPAR) 7 Total Number of Guests 8 Number of Lodging Employees 0% 0 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 17 Covered Slips 18 Uncovered Slips 19 Rental Boats and Houseboats 20 Dry Storage Units 21 Linear Feet of Wet Moorage 22 Number of Marina Employees TRANSPORTATION / TOUR / GUIDE SERVICE 23 (Type of Trip/Tour) 24 (Type of Trip/Tour) 25 (Type of Trip/Tour) 26 (Type of Trip/Tour) 27 (Type of Trip/Tour) 28 Number of Transportation Employees CAMPGROUNDS 29 Campground Sites 30 Number of Campground Employees CONCESSION EMPLOYEES 31 Permanent year around employees 32 Filled seasonal positions 33 Estimated total full-time equivalents (One FTE = 2,080 hours) CONCESSION EMPLOYEE HOUSING 34 Employee Beds Number Available Average Occupied Occupancy Rate 0% 0% 0% 0% Annual Trips Annual Riders Riders per Trip 0 0 0 0 0 Number Available Average Occupied Occupancy Rate 0% Annual Number Available Average Occupied Total Per Occupied Bed 0.00 Occupancy Rate 0% 35 Direct Housing Expense Page 9 SCHEDULE M2 - OPERATIONAL STATISTICS 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 5 Average Daily Room Rate (ADR) 6 Revenue Per Available Room (RevPAR) 7 Total Number of Guests 8 Number of Lodging Employees 0% 0 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 17 Covered Slips 18 Uncovered Slips 19 Rental Boats and Houseboats 20 Dry Storage Units 21 Linear Feet of Wet Moorage 22 Number of Marina Employees TRANSPORTATION / TOUR / GUIDE SERVICE 23 (Type of Trip/Tour) 24 (Type of Trip/Tour) 25 (Type of Trip/Tour) 26 (Type of Trip/Tour) 27 (Type of Trip/Tour) 28 Number of Transportation Employees CAMPGROUNDS 29 Campground Sites 30 Number of Campground Employees Number Available Average Occupied Occupancy Rate 0% 0% 0% 0% Annual Trips Annual Riders Riders per Trip 0 0 0 0 0 Number Available Average Occupied Occupancy Rate 0% Page 10 SCHEDULE M3 - OPERATIONAL STATISTICS 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 5 Average Daily Room Rate (ADR) 6 Revenue Per Available Room (RevPAR) 7 Total Number of Guests 8 Number of Lodging Employees 0% 0 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 17 Covered Slips 18 Uncovered Slips 19 Rental Boats and Houseboats 20 Dry Storage Units 21 Linear Feet of Wet Moorage 22 Number of Marina Employees TRANSPORTATION / TOUR / GUIDE SERVICE 23 (Type of Trip/Tour) 24 (Type of Trip/Tour) 25 (Type of Trip/Tour) 26 (Type of Trip/Tour) 27 (Type of Trip/Tour) 28 Number of Transportation Employees CAMPGROUNDS 29 Campground Sites 30 Number of Campground Employees Number Available Average Occupied Occupancy Rate 0% 0% 0% 0% Annual Trips Annual Riders Riders per Trip 0 0 0 0 0 Number Available Average Occupied Occupancy Rate 0% Page 11 SCHEDULE M4 - OPERATIONAL STATISTICS 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 5 Average Daily Room Rate (ADR) 6 Revenue Per Available Room (RevPAR) 7 Total Number of Guests 8 Number of Lodging Employees 0% 0 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 17 Covered Slips 18 Uncovered Slips 19 Rental Boats and Houseboats 20 Dry Storage Units 21 Linear Feet of Wet Moorage 22 Number of Marina Employees TRANSPORTATION / TOUR / GUIDE SERVICE 23 (Type of Trip/Tour) 24 (Type of Trip/Tour) 25 (Type of Trip/Tour) 26 (Type of Trip/Tour) 27 (Type of Trip/Tour) 28 Number of Transportation Employees CAMPGROUNDS 29 Campground Sites 30 Number of Campground Employees Number Available Average Occupied Occupancy Rate 0% 0% 0% 0% Annual Trips Annual Riders Riders per Trip 0 0 0 0 0 Number Available Average Occupied Occupancy Rate 0% Page 12 SCHEDULE M5 - OPERATIONAL STATISTICS 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 5 Average Daily Room Rate (ADR) 6 Revenue Per Available Room (RevPAR) 7 Total Number of Guests 8 Number of Lodging Employees 0% 0 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 17 Covered Slips 18 Uncovered Slips 19 Rental Boats and Houseboats 20 Dry Storage Units 21 Linear Feet of Wet Moorage 22 Number of Marina Employees TRANSPORTATION / TOUR / GUIDE SERVICE 23 (Type of Trip/Tour) 24 (Type of Trip/Tour) 25 (Type of Trip/Tour) 26 (Type of Trip/Tour) 27 (Type of Trip/Tour) 28 Number of Transportation Employees CAMPGROUNDS 29 Campground Sites 30 Number of Campground Employees Number Available Average Occupied Occupancy Rate 0% 0% 0% 0% Annual Trips Annual Riders Riders per Trip 0 0 0 0 0 Number Available Average Occupied Occupancy Rate 0% Page 13 SCHEDULE M6 - OPERATIONAL STATISTICS 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 5 Average Daily Room Rate (ADR) 6 Revenue Per Available Room (RevPAR) 7 Total Number of Guests 8 Number of Lodging Employees 0% 0 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 17 Covered Slips 18 Uncovered Slips 19 Rental Boats and Houseboats 20 Dry Storage Units 21 Linear Feet of Wet Moorage 22 Number of Marina Employees TRANSPORTATION / TOUR / GUIDE SERVICE 23 (Type of Trip/Tour) 24 (Type of Trip/Tour) 25 (Type of Trip/Tour) 26 (Type of Trip/Tour) 27 (Type of Trip/Tour) 28 Number of Transportation Employees CAMPGROUNDS 29 Campground Sites 30 Number of Campground Employees Number Available Average Occupied Occupancy Rate 0% 0% 0% 0% Annual Trips Annual Riders Riders per Trip 0 0 0 0 0 Number Available Average Occupied Occupancy Rate 0% Page 14 SCHEDULE M7 - OPERATIONAL STATISTICS 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 5 Average Daily Room Rate (ADR) 6 Revenue Per Available Room (RevPAR) 7 Total Number of Guests 8 Number of Lodging Employees 0% 0 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 17 Covered Slips 18 Uncovered Slips 19 Rental Boats and Houseboats 20 Dry Storage Units 21 Linear Feet of Wet Moorage 22 Number of Marina Employees TRANSPORTATION / TOUR / GUIDE SERVICE 23 (Type of Trip/Tour) 24 (Type of Trip/Tour) 25 (Type of Trip/Tour) 26 (Type of Trip/Tour) 27 (Type of Trip/Tour) 28 Number of Transportation Employees CAMPGROUNDS 29 Campground Sites 30 Number of Campground Employees Number Available Average Occupied Occupancy Rate 0% 0% 0% 0% Annual Trips Annual Riders Riders per Trip 0 0 0 0 0 Number Available Average Occupied Occupancy Rate 0% Page 15 Concessioner Info, Type of Entity Corporation S Corporation B Corporation Limited Liability Company Partnership Sole Proprietorship Other Concessioner Info, Proration Yes No Concessioner Info, Proration Items Revenue Expenses Revenue and Expenses Concessioner Info, Proration Methods prorated based on percentage of sales incurred in the park prorated based on time spent in the park prorated based on miles traveled in the park