the discussion of indications for use and representative or target procedures is intended solely to provide an understanding of the market for da vinci products but is not intended to promote for sale or use any intuitive surgical product outside of its licensed or cleared labeling and indications for use . the adoption of da vinci surgery has the potential to grow for those procedures that offer greater patient value than non- da vinci alternatives , within the prevailing economics of healthcare providers . da vinci surgical systems are used primarily in gynecologic surgery , general surgery , urologic surgery , cardiothoracic surgery , and head and neck surgery . we focus our organization and investments on developing , marketing , and training for those products and procedures where da vinci can bring greater patient value relative to alternative treatment options and or economic benefit to health care providers . target procedures in gynecology include da vinci hysterectomy ( “ dvh ” ) , for both cancer and benign procedures , and sacrocolpopexy . target procedures in general surgery include hernia repair ( both ventral and inguinal ) , colorectal procedures , and cholecystectomy . target procedures in urology 37 include da vinci prostatectomy ( “ dvp ” ) and partial nephrectomy . in cardiothoracic surgery , target procedures include da vinci lobectomy and da vinci mitral valve repair . in head and neck surgery , target procedures include certain procedures resecting benign and malignant tumors classified as t1 and t2 . not all the indications , procedures , or products described may be available in a given country or region or on all generations of da vinci surgical systems . patients need to consult the product labeling in a specific country and for each product in order to determine the actual authorized uses , as well as important limitations , restrictions , or contraindications . in 2015 , approximately 652,000 surgical procedures were performed with the da vinci surgical system , compared with approximately 570,000 and 523,000 procedures performed in 2014 and 2013 , respectively . the growth in our overall procedure volume in 2015 was driven by growth in u.s. general surgery procedures and worldwide urologic procedures . u.s. procedures overall u.s. procedure volume grew to approximately 499,000 in 2015 , compared with approximately 449,000 in 2014 , and approximately 422,000 in 2013 . gynecology is our largest u.s. surgical specialty and the procedure volume was approximately 238,000 in 2015 , compared with 235,000 in 2014 and 240,000 in 2013 . general surgery is our second largest and fastest growing specialty in the u.s. with procedure volume that grew to approximately 140,000 in 2015 , compared with approximately 107,000 in 2014 and 81,000 in 2013 . u.s. urology procedure volume was approximately 102,000 in 2015 , compared with approximately 91,000 in 2014 , and 85,000 in 2013 . procedures outside of the u.s. overall procedures outside of the u.s. ( “ ous ” ) grew to approximately 153,000 in 2015 , compared with approximately 121,000 in 2014 and approximately 101,000 in 2013 . ous procedure growth accelerated in 2015 , reflecting higher asian procedure volumes , most notably in china , japan , and south korea . procedure volume grew at a similar rate in 2015 as compared with 2014. procedure growth in most ous markets was driven largely by dvp volume , which grew to approximately 79,000 in 2015 , compared with approximately 65,000 in 2014 , and approximately 56,000 in 2013 . partial nephrectomy , general surgery , and gynecologic oncology procedures also contributed to ous procedure growth . see recent business events and trends for further discussion on u.s. and ous procedures . business model we generate revenue from both the initial capital sales of da vinci surgical systems and from subsequent sales of instruments , accessories and service , as recurring revenue . the da vinci surgical system generally sells for approximately between $ 0.6 million and $ 2.5 million , depending upon configuration and geography , and represents a significant capital equipment investment for our customers . we generate recurring revenue as our customers purchase our endowrist and single-site instrument and accessory products used in performing procedures with the da vinci surgical system . our instruments and accessories have a limited life and will either expire or wear out as they are used in surgery , at which point they are replaced . also , we generate recurring revenue from ongoing system service . we typically enter into service contracts at the time systems are sold at an annual rate of approximately $ 100,000 to $ 170,000 per year , depending upon the configuration of the underlying system and composition of the services offered under the contract . these service contracts have generally been renewed at the end of the initial contractual service periods . recurring revenue has generally grown at a faster rate than system revenue in the last few fiscal years . recurring revenue increased to $ 1.7 billion , or 70 % of total revenue in 2015 , compared with $ 1.5 billion , or 70 % of total revenue in 2014 and $ 1.4 billion , or 63 % of total revenue in 2013 . the growth of recurring revenue and its increasing proportion of total revenue largely reflect continued procedure adoption on a growing base of installed da vinci surgical systems . the installed base of da vinci surgical systems has grown to approximately 3,597 at december 31 , 2015 , compared with 3,266 at december 31 , 2014 , and 2,966 at december 31 , 2013 . we provide our products through direct sales organizations in the u.s. , japan , south korea , and europe , excluding spain , portugal , italy , greece , and eastern european countries . in the remainder of our ous markets , we provide our products through distributors . story_separator_special_tag u.s. dvp is the largest urology procedure in the u.s. with 66,000 dvps performed in 2015 , compared with 60,000 in 2014 , and 58,000 in 2013. we believe the 2011 u.s. preventive services task force ( “ usptf ” ) recommendation against prostate-specific antigen ( ( “ psa ” ) screening has impacted our u.s. dvp procedure volumes , as well as caused changes in treatment patterns for low risk prostate cancer away from definitive treatment , and contributed to an approximate 6 % decline in our dvp business in 2013. after continuing to decline during the first half of 2014 , u.s. dvp returned to growth during the second half of 2014 and accelerated to approximately 11 % growth in 2015. as the u.s. standard of care for the surgical treatment of prostate cancer , we expect that the number of dvp procedures performed in the u.s. will fluctuate with the overall prostatectomy market . we believe the return to growth in dvp reflects surgical procedures being performed for men who may have previously deferred psa testing or definitive treatment . dvp adoption in our markets outside of the u.s. is at earlier stages , with lower market penetration , and has continued to grow since the usptf recommendation and despite shifting patient treatment trends that have negatively impacted the overall prostatectomy volumes in certain countries . procedure seasonality . more than half of da vinci procedures performed are for benign conditions , most notably benign hysterectomies , hernia repairs , and cholecystectomies . the proportion of these benign procedures has grown over time in relation to the total number of procedures performed . hysterectomies for benign conditions , hernia repairs , cholecystectomies , and other short-term elective procedures tend to be more seasonal than cancer operations and surgeries for other life threatening conditions . seasonality for these benign procedures results in higher fourth quarter procedure volume when more patients have met annual deductibles and lower first quarter procedure volume when deductibles are reset . seasonality for 2015 was similar to years prior to 2014 , with higher procedure volumes in the fourth quarter , and less pronounced than in early 2014 , when we believe procedure volume was negatively impacted by transitional issues associated with the implementation of the affordable care act . procedure mix . our procedure business is primarily comprised of : ( 1 ) cancer and other highly complex procedures and ( 2 ) less complex benign procedures . cancer and other highly complex procedures tend to be reimbursed at higher rates than less complex benign procedures . thus , hospitals are more sensitive to the costs associated with treating less complex benign conditions . our strategy is to provide hospitals with attractive clinical and economic solutions in each of these procedure categories . more fully featured products , including 4-arm , dual console , firefly enabled systems , and advanced instruments including vessel sealing and stapler are targeted towards more complex procedures . lower priced products , including three-arm da vinci si-e systems , refurbished da vinci si , and lower priced single-site instruments are targeted towards less complex procedures . fda actions concerning morcellation . in april 2014 , the fda announced that it discourages the use of power morcellators in the surgical removal of assumed benign fibroids . this statement was followed in july 2014 by an fda panel discussion on the topic . in november 2014 , the fda issued specific contraindications for the use of laparoscopic power morcellation and required specific patient warning prior to its use in surgery . we do not manufacture or sell power morcellation products , and power morcellators do not attach to da vinci surgical systems . minimally invasive da vinci gynecologic surgeries are routinely performed without the use of power morcellators . however , we believe that these fda actions likely created some uncertainty for surgeons and patients when choosing among minimally invasive surgical methods for removing fibroids that may have adversely impacted the number of da vinci procedures performed . since the second quarter of 2014 , we have experienced a decline in myomectomies that we believe likely reflected the impact of the fda actions . myomectomies are not a significant portion of our business . it is difficult to gauge what impact the fda actions may have had on benign dvh procedures , although as indicated above , an increasing proportion of our hysterectomy procedures in recent quarters have been performed by gynecologic oncologists . system demand future demand for da vinci surgical systems will be impacted by factors including procedure growth rates , market response to our recently launched da vinci xi surgical system , hospitals consolidation trends , evolving system utilization and point of care dynamics , additional reimbursements in various global markets including japan , the timing around governmental tenders and authorizations , the timing of when we receive regulatory clearances in our other ous markets for our xi system and related instruments . future demand may also be impacted by anticipated robotic surgery competition , which is further described in the competition section included in part i , item 1. recent media and lawsuits in recent years , various print , television , and internet media have released pieces questioning the patient safety and efficacy associated with da vinci surgery , the cost of da vinci surgery relative to other disease management methods , and the adequacy of surgeon training and our sales and marketing practices . in addition , as further described in note 7 to the consolidated financial 42 statements included in part ii , item 8 , we are currently named as a defendant in approximately 92 individual product liability lawsuits and a multi-plaintiff product liability lawsuit filed on behalf of 55 patients who underwent da vinci surgery . plaintiffs ' attorneys have been engaged in well-funded national advertising campaigns soliciting clients who have undergone da vinci surgery and claim to have suffered an

liquidity and capital resources sources and uses of cash our principal source of liquidity is cash provided by operations and issuance of common stock through exercise of stock options and our employee stock purchase program . cash and cash equivalents plus short and long-term investments increased by $ 0.8 billion to $ 3.3 billion at december 31 , 2015 , from $ 2.5 billion at december 31 , 2014 . cash and cash equivalents plus short and long-term investments decreased from $ 2.8 billion at december 31 , 2013 , to $ 2.5 billion at december 31 , 2014 , primarily due to the repurchase of $ 1.0 billion stock during 2014 . cash generation is one of our fundamental strengths and provides us with substantial financial flexibility in meeting our operating , investing , and financing needs . as of december 31 , 2015 , $ 987.2 million of our cash , cash equivalents and investments were held by foreign subsidiaries . amounts held by foreign subsidiaries are generally subject to u.s. income tax on repatriation to the u.s. we currently have no plans to repatriate any foreign earnings back to the u.s. as we believe our cash flows provided by our u.s. operations will meet our u.s. liquidity needs for the foreseeable future . see “ item 7a . quantitative and qualitative disclosures about market risk ” for discussion on the impact of interest rate risk and market risk on our investment portfolio . consolidated cash flow data replace_table_token_6_th operating activities for the year ended december 31 , 2015 , cash provided by our operating activities of $ 771.9 million exceeded our net income of $ 588.8 million for two primary reasons : 1. our net income included non-cash charges primarily in the form of share-based compensation of $ 167.9 million , depreciation and loss of disposal of property , plant , and equipment of $ 65.1 million , income tax benefits from employee stock plans of $ 21.5 million , amortization of intangible assets of $ 24.4 million , and accretion of discounts and amortization of premiums on investments of $ 26.4 million .


 Write a concise suspicious activity report of the following text delimited by triple backquotes. Return your response as a formal report which covers the key points highlighting the location,dates,entity names and account holder information in chronological order of the text.
     ```liquidity and capital resources sources and uses of cash our principal source of liquidity is cash provided by operations and issuance of common stock through exercise of stock options and our employee stock purchase program . cash and cash equivalents plus short and long-term investments increased by $ 0.8 billion to $ 3.3 billion at december 31 , 2015 , from $ 2.5 billion at december 31 , 2014 . cash and cash equivalents plus short and long-term investments decreased from $ 2.8 billion at december 31 , 2013 , to $ 2.5 billion at december 31 , 2014 , primarily due to the repurchase of $ 1.0 billion stock during 2014 . cash generation is one of our fundamental strengths and provides us with substantial financial flexibility in meeting our operating , investing , and financing needs . as of december 31 , 2015 , $ 987.2 million of our cash , cash equivalents and investments were held by foreign subsidiaries . amounts held by foreign subsidiaries are generally subject to u.s. income tax on repatriation to the u.s. we currently have no plans to repatriate any foreign earnings back to the u.s. as we believe our cash flows provided by our u.s. operations will meet our u.s. liquidity needs for the foreseeable future . see “ item 7a . quantitative and qualitative disclosures about market risk ” for discussion on the impact of interest rate risk and market risk on our investment portfolio . consolidated cash flow data replace_table_token_6_th operating activities for the year ended december 31 , 2015 , cash provided by our operating activities of $ 771.9 million exceeded our net income of $ 588.8 million for two primary reasons : 1. our net income included non-cash charges primarily in the form of share-based compensation of $ 167.9 million , depreciation and loss of disposal of property , plant , and equipment of $ 65.1 million , income tax benefits from employee stock plans of $ 21.5 million , amortization of intangible assets of $ 24.4 million , and accretion of discounts and amortization of premiums on investments of $ 26.4 million .
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 Suspicious Activity Report : the discussion of indications for use and representative or target procedures is intended solely to provide an understanding of the market for da vinci products but is not intended to promote for sale or use any intuitive surgical product outside of its licensed or cleared labeling and indications for use . the adoption of da vinci surgery has the potential to grow for those procedures that offer greater patient value than non- da vinci alternatives , within the prevailing economics of healthcare providers . da vinci surgical systems are used primarily in gynecologic surgery , general surgery , urologic surgery , cardiothoracic surgery , and head and neck surgery . we focus our organization and investments on developing , marketing , and training for those products and procedures where da vinci can bring greater patient value relative to alternative treatment options and or economic benefit to health care providers . target procedures in gynecology include da vinci hysterectomy ( “ dvh ” ) , for both cancer and benign procedures , and sacrocolpopexy . target procedures in general surgery include hernia repair ( both ventral and inguinal ) , colorectal procedures , and cholecystectomy . target procedures in urology 37 include da vinci prostatectomy ( “ dvp ” ) and partial nephrectomy . in cardiothoracic surgery , target procedures include da vinci lobectomy and da vinci mitral valve repair . in head and neck surgery , target procedures include certain procedures resecting benign and malignant tumors classified as t1 and t2 . not all the indications , procedures , or products described may be available in a given country or region or on all generations of da vinci surgical systems . patients need to consult the product labeling in a specific country and for each product in order to determine the actual authorized uses , as well as important limitations , restrictions , or contraindications . in 2015 , approximately 652,000 surgical procedures were performed with the da vinci surgical system , compared with approximately 570,000 and 523,000 procedures performed in 2014 and 2013 , respectively . the growth in our overall procedure volume in 2015 was driven by growth in u.s. general surgery procedures and worldwide urologic procedures . u.s. procedures overall u.s. procedure volume grew to approximately 499,000 in 2015 , compared with approximately 449,000 in 2014 , and approximately 422,000 in 2013 . gynecology is our largest u.s. surgical specialty and the procedure volume was approximately 238,000 in 2015 , compared with 235,000 in 2014 and 240,000 in 2013 . general surgery is our second largest and fastest growing specialty in the u.s. with procedure volume that grew to approximately 140,000 in 2015 , compared with approximately 107,000 in 2014 and 81,000 in 2013 . u.s. urology procedure volume was approximately 102,000 in 2015 , compared with approximately 91,000 in 2014 , and 85,000 in 2013 . procedures outside of the u.s. overall procedures outside of the u.s. ( “ ous ” ) grew to approximately 153,000 in 2015 , compared with approximately 121,000 in 2014 and approximately 101,000 in 2013 . ous procedure growth accelerated in 2015 , reflecting higher asian procedure volumes , most notably in china , japan , and south korea . procedure volume grew at a similar rate in 2015 as compared with 2014. procedure growth in most ous markets was driven largely by dvp volume , which grew to approximately 79,000 in 2015 , compared with approximately 65,000 in 2014 , and approximately 56,000 in 2013 . partial nephrectomy , general surgery , and gynecologic oncology procedures also contributed to ous procedure growth . see recent business events and trends for further discussion on u.s. and ous procedures . business model we generate revenue from both the initial capital sales of da vinci surgical systems and from subsequent sales of instruments , accessories and service , as recurring revenue . the da vinci surgical system generally sells for approximately between $ 0.6 million and $ 2.5 million , depending upon configuration and geography , and represents a significant capital equipment investment for our customers . we generate recurring revenue as our customers purchase our endowrist and single-site instrument and accessory products used in performing procedures with the da vinci surgical system . our instruments and accessories have a limited life and will either expire or wear out as they are used in surgery , at which point they are replaced . also , we generate recurring revenue from ongoing system service . we typically enter into service contracts at the time systems are sold at an annual rate of approximately $ 100,000 to $ 170,000 per year , depending upon the configuration of the underlying system and composition of the services offered under the contract . these service contracts have generally been renewed at the end of the initial contractual service periods . recurring revenue has generally grown at a faster rate than system revenue in the last few fiscal years . recurring revenue increased to $ 1.7 billion , or 70 % of total revenue in 2015 , compared with $ 1.5 billion , or 70 % of total revenue in 2014 and $ 1.4 billion , or 63 % of total revenue in 2013 . the growth of recurring revenue and its increasing proportion of total revenue largely reflect continued procedure adoption on a growing base of installed da vinci surgical systems . the installed base of da vinci surgical systems has grown to approximately 3,597 at december 31 , 2015 , compared with 3,266 at december 31 , 2014 , and 2,966 at december 31 , 2013 . we provide our products through direct sales organizations in the u.s. , japan , south korea , and europe , excluding spain , portugal , italy , greece , and eastern european countries . in the remainder of our ous markets , we provide our products through distributors . story_separator_special_tag u.s. dvp is the largest urology procedure in the u.s. with 66,000 dvps performed in 2015 , compared with 60,000 in 2014 , and 58,000 in 2013. we believe the 2011 u.s. preventive services task force ( “ usptf ” ) recommendation against prostate-specific antigen ( ( “ psa ” ) screening has impacted our u.s. dvp procedure volumes , as well as caused changes in treatment patterns for low risk prostate cancer away from definitive treatment , and contributed to an approximate 6 % decline in our dvp business in 2013. after continuing to decline during the first half of 2014 , u.s. dvp returned to growth during the second half of 2014 and accelerated to approximately 11 % growth in 2015. as the u.s. standard of care for the surgical treatment of prostate cancer , we expect that the number of dvp procedures performed in the u.s. will fluctuate with the overall prostatectomy market . we believe the return to growth in dvp reflects surgical procedures being performed for men who may have previously deferred psa testing or definitive treatment . dvp adoption in our markets outside of the u.s. is at earlier stages , with lower market penetration , and has continued to grow since the usptf recommendation and despite shifting patient treatment trends that have negatively impacted the overall prostatectomy volumes in certain countries . procedure seasonality . more than half of da vinci procedures performed are for benign conditions , most notably benign hysterectomies , hernia repairs , and cholecystectomies . the proportion of these benign procedures has grown over time in relation to the total number of procedures performed . hysterectomies for benign conditions , hernia repairs , cholecystectomies , and other short-term elective procedures tend to be more seasonal than cancer operations and surgeries for other life threatening conditions . seasonality for these benign procedures results in higher fourth quarter procedure volume when more patients have met annual deductibles and lower first quarter procedure volume when deductibles are reset . seasonality for 2015 was similar to years prior to 2014 , with higher procedure volumes in the fourth quarter , and less pronounced than in early 2014 , when we believe procedure volume was negatively impacted by transitional issues associated with the implementation of the affordable care act . procedure mix . our procedure business is primarily comprised of : ( 1 ) cancer and other highly complex procedures and ( 2 ) less complex benign procedures . cancer and other highly complex procedures tend to be reimbursed at higher rates than less complex benign procedures . thus , hospitals are more sensitive to the costs associated with treating less complex benign conditions . our strategy is to provide hospitals with attractive clinical and economic solutions in each of these procedure categories . more fully featured products , including 4-arm , dual console , firefly enabled systems , and advanced instruments including vessel sealing and stapler are targeted towards more complex procedures . lower priced products , including three-arm da vinci si-e systems , refurbished da vinci si , and lower priced single-site instruments are targeted towards less complex procedures . fda actions concerning morcellation . in april 2014 , the fda announced that it discourages the use of power morcellators in the surgical removal of assumed benign fibroids . this statement was followed in july 2014 by an fda panel discussion on the topic . in november 2014 , the fda issued specific contraindications for the use of laparoscopic power morcellation and required specific patient warning prior to its use in surgery . we do not manufacture or sell power morcellation products , and power morcellators do not attach to da vinci surgical systems . minimally invasive da vinci gynecologic surgeries are routinely performed without the use of power morcellators . however , we believe that these fda actions likely created some uncertainty for surgeons and patients when choosing among minimally invasive surgical methods for removing fibroids that may have adversely impacted the number of da vinci procedures performed . since the second quarter of 2014 , we have experienced a decline in myomectomies that we believe likely reflected the impact of the fda actions . myomectomies are not a significant portion of our business . it is difficult to gauge what impact the fda actions may have had on benign dvh procedures , although as indicated above , an increasing proportion of our hysterectomy procedures in recent quarters have been performed by gynecologic oncologists . system demand future demand for da vinci surgical systems will be impacted by factors including procedure growth rates , market response to our recently launched da vinci xi surgical system , hospitals consolidation trends , evolving system utilization and point of care dynamics , additional reimbursements in various global markets including japan , the timing around governmental tenders and authorizations , the timing of when we receive regulatory clearances in our other ous markets for our xi system and related instruments . future demand may also be impacted by anticipated robotic surgery competition , which is further described in the competition section included in part i , item 1. recent media and lawsuits in recent years , various print , television , and internet media have released pieces questioning the patient safety and efficacy associated with da vinci surgery , the cost of da vinci surgery relative to other disease management methods , and the adequacy of surgeon training and our sales and marketing practices . in addition , as further described in note 7 to the consolidated financial 42 statements included in part ii , item 8 , we are currently named as a defendant in approximately 92 individual product liability lawsuits and a multi-plaintiff product liability lawsuit filed on behalf of 55 patients who underwent da vinci surgery . plaintiffs ' attorneys have been engaged in well-funded national advertising campaigns soliciting clients who have undergone da vinci surgery and claim to have suffered an

