Exhibit C

0202-EX-ST-2016 Text Documents

MC10 Inc.

2016-02-17ELS_172918

REDACTED FOR PUBLIC INSPECTION February 10, 2016 Federal Communications Commission 445 12th Street, SW Washington, DC 20554 Re: Request for Confidential Treatment MC10, Inc. (“MC10”) submits this application for Special Temporary Authority (the “Application”) addressing those matters which the Application is required to address under 47 CFR5.61. By separate letter, MC10 requests confidential treatment of certain portions of Exhibit A to the Application. Pursuant to 47 CFR 5.53 and 5.54, the “public redacted” version of Exhibit A to MC10’s Application is set forth in Exhibit C to the Application.

REDACTED FOR PUBLIC INSPECTION Exhibit A to MC10 Special Temporary Authority Application 1. Detailed explanation of why the STA is needed. The Special Temporary Authority (STA) is required for conducting an experimental study with the Massachusetts General Hospital (MGH) using Proof of Concept devices designed and manufactured by MC10, Inc. The purpose of this study is to further the development of a novel experimental medical device that can log heart-rate over the course of 24 hours. In particular, these devices will be useful for characterizing and quantifying heart-rate for rate controlled patients suffering from atrial fibrillation. The learnings from this experiment will help drive improvements to both device hardware and software architectures, facilitating the pathway for the device to be released to market. Per its Institution Review Board (IRB) application process, MGH has requested that MC10 obtain an STA from the FCC for wireless devices used in experimental studies. The MC10 device uses a Commercial Off- the-Shelf (COTS) Near-Field Communications (NFC) tag and a custom inductive coil antenna. To facilitate the execution of the study and further MC10 innovation and technology development, the STA represents the most effective means for completing the study in a reasonable time frame. Furthermore, the six month exemption the STA offers is an ample amount of time for MC10 to properly deploy, use and evaluate the performance of the device for this study. 2. Detailed explanation on the type of operation that will be performed. The study will involve patient volunteers who wear a MC10 designed and manufactured Proof of Concept device (patch) to monitor heart-rate over the course of 24 hours. An MGH clinician will use an NFC-enabled mobile device, Samsung S5 Android phone, to activate the patch and take an initial heart- rate and ECG reading. Once the patch is activated, it will continue to log heart-rate to internal memory. The device does not transmit any information while logging. The patient will be sent home. After 24 hours, the patient will return to the clinic. The clinician will bring the Samsung S5 within 1cm of the patch and heart-rate data will be transferred to the Samsung S5. In both cases, for initial and final data transfers, the NFC-enabled mobile device, Samsung S5, must be within 1cm of the patch’s magnetic coupling range to transfer information. Data communication takes approximately 30 seconds. Wireless transmission is limited to those two instances. Furthermore, according to the NFC standard, the patch modulates the magnetic-field signal from the Samsung S5 and does not actively transmit or broadcast power on its own. No Personally Identifiable Information will be telemetered via the device. In addition, all data is encrypted from end to end with AES128 encryption. The volunteer will wear the device for 24 hours after which time the device will be returned to MC10. Technical Details The MC10 experimental device contains an NXP NT3H1101 NFC Type 2 tag. It is passive and does not intentionally emit any RF energy. Rather, it modulates the signal emitted by an NFC-enabled Mobile

REDACTED FOR PUBLIC INSPECTION device, rectifying both power and data. In the case of the study, the Mobile device is a Samsung S5 (Model SM-G900H. FCC ID: A3LSMG900H). When the MC10 device is brought within 1cm of the Samsung S5, the latter transmits a modulated 13.56MHz signal through its coil antenna. The NT3H1101 NFC IC in the MC10 device demodulates the signal and rectifies it for power. Using the NT3H1101 NFC IC, the MC10 device can also modulate the incoming 13.56MHz signal to communicate with the S5. The MC10 NFC antenna is a planar coil with N = 3 turns with the following physical dimensions: 57mm x 25mm area; 12 mil trace width and 12µm trace height. 3. Description of the Geographical location and environment the operation will be performed. The device will be used inside the Holter Lab at Mass General Hospital 55 Fruit Street Boston, MA 02114 NAD 83 Latitude: 42.3631°N = 42° 21' 47.2"N Longitude: 71.0694°W = 71° 04' 9.8"W 4. Description of any and all associated equipment used during operation A Samsung S5 smart phone will be used to perform initialization (30 sec data transfer at the start of the study) and final data transfer (30 sec data transfer at the end of the study). Between the initial and final data transfers, the MC10 medical device is not modulating any magnetic field signal. Model number: Samsung Galaxy S5 SM-G900H FCC ID: A3LSMG900H 5. Letter requesting confidentiality (if desired). Per CFR Title 47 0.457(d) and 0.459


Document Created: 2016-02-11 13:11:03
Document Modified: 2016-02-11 13:11:03
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