EXHIBIT C HCP CONSULTING AGREEMENT SERVICES REPORT ALL INFORMATION MUST BE TYPED Consultant Name: Natan Zundel, MD NPI #: 1174784052 For Services Performed during the Following Month and Year: February 2021 SERVICES Date of Service Name of Olympus Employee (No date ranges. Coordinating Service Description of Service Performed List each date separately.) 02.09.2021 02.23.2021 Prep Work Virtual Education Event Virtual Education Event Rachael Perkins Rachael Perkins Rachael Perkins Duration of Services (Expressed in Hours) 2.00 2.25 Total Hours of Services Rendered: ___________ TRAVEL TIME Date of Travel Method of Travel (e.g. air, train, car, etc.) Destination from to Hours of Travel Time Total Hours of Travel Time: ____N/A________ TRAVEL EXPENSES/REIMBURSEMENTS (If authorized and applicable) Travel Expenses (receipts required): Description of Expense Date of Expense (please specify breakfast, lunch, dinner, hotel, taxi, etc.) Amount $ Total Amount of Travel Expenses/Reimbursements: $________N/A_______ For U.S. Licensed Consultant, Consultant is advised that Olympus will comply with applicable federal and state laws and regulations that require Olympus to disclose to certain government authorities information regarding compensation Olympus furnishes to, and expenses Olympus reimburses to or covers for, Consultant which authorities may in turn publicly post or report the information. Such disclosed information may include, but may not be limited to, Consultant's name, Consultant's business address, Consultant's National Provider Identifier, and the nature and value of any compensation and expenses that Olympus furnishes to Consultant. CERTIFICATION Consultant hereby certifies and attests that the information provided on this Consulting Agreement Services Report accurately reflects the Services performed and the time spent providing said Services, and that Consultant provided Services in compliance with Consultant’s Consulting Agreement. Consultant further hereby certifies and attests that Consultant has completed Olympus required Compliance Training as directed by Olympus and that such training was completed within one (1) year of the date of performance of the Services. Consultant Signature: ____________________________________________ Date: ________________
