our pharos laser is a medical device that we have marketed since october 2004 as a tool for the treatment of proliferative skin conditions including psoriasis , vitiligo , atopic dermatitis , and leukoderma . the covid-19 pandemic is negatively impacting the dermatology business as many customers delay the acquisition or purchase of capital equipment such as our pharos laser . because this business does not have a disposables component and we augment our capital equipment sales with recurring revenue derived from service and or rental or lease agreements , we are experiencing less of an impact than business models that rely solely on capital equipment and or disposables sales . we continue to evaluate our overall strategy for the dermatology business and believe there could be an opportunity to grow revenues and increase its cash contribution in the future . changes to our dermatology business strategy , as well as the timing of those potential changes , will be influenced by the continued impact of the covid-19 pandemic . recent developments covid-19 the global spread of the novel coronavirus ( covid-19 ) has created significant volatility , uncertainty and economic disruption . the ultimate effects of the covid-19 on our business , operations and financial condition are unknown at this time . in the near term , we expect that our revenue will continue to be adversely impacted and enrollment in our atherectomy clinical trial will continue to be delayed or slowed , as patients elect to postpone voluntary treatments and physicians ' offices are either closed or operating at a reduced capacity . in addition , some customers are requesting more flexible payment terms on a temporary basis . we also may not be able to secure additional financing in a timely manner or on favorable terms , if at all . our manufacturing facility located in carlsbad , california is currently operational . employee travel is limited to essential travel only and many employees are working from home when feasible . we have experienced minor delays in receiving shipments of parts , which has affected the timing of our key engineering efforts . to date , the shipment delays have not had a material impact on our ability to support our atherectomy indication trial . however , the extent to which covid-19 impacts our business will depend on future developments , which are highly uncertain and can not be predicted , including new information which may emerge concerning the severity of covid-19 and the actions to contain it or treat its impact , among others . reverse stock split on november 16 , 2020 , we filed a certificate of amendment to the certificate of incorporation with the secretary of state of the state of delaware to effect a reverse stock split of our common stock at a ratio of one-for-twenty-five , or the reverse stock split . the reverse stock split became effective as of 4:01 p.m. eastern time on november 16 , 2020 , and our common stock began trading on the new york stock exchange on a post-split basis on november 17 , 2020. unless otherwise noted , all share and per share numbers contained in this annual report are reflected on a post-split basis for all periods presented . nyse american on december 17 , 2020 , we received approval to list our common stock on the nyse american and provided written notice to the new york stock exchange , or the nyse , of our intention to list our common stock on nyse american and to simultaneously delist such securities from the nyse . our final day trading on the nyse was on december 21 , 2020 and we commenced trading on nyse american on december 22 , 2020 under our current stock symbol “ rmed . ” components of our results of operations net revenue product sales consist of the sale of dabra and pharos lasers , the sale of catheters for use with the dabra laser and the sale of consumables and replacement parts . 89 service and other revenue consists primarily of sales of extended warranties , which we recognize over the contract period and billable services , including repair activity , which is recognized when the service is provided . it also includes income from the rental of our lasers . we currently use our commercial team to service the u.s. market , and we utilize distributors outside the u.s. in markets where we have received regulatory approval . we expect to continue to seek regulatory approvals for our products in additional strategic markets . cost of revenue and gross profit ( loss ) cost of revenue for product sales consists primarily of costs of components for use in our products , the labor that are used to produce our products , and the manufacturing overhead that support production . cost of revenue for service and other includes the cost of maintaining and servicing the warranties on our products , including the depreciation on lasers we own . we expect cost of revenue to increase to the extent our total revenue grows . we calculate gross profit ( loss ) as revenue less cost of revenue . our gross profit ( loss ) has been and will continue to be affected by a variety of factors , primarily production volumes , the cost of direct materials , discounting practices , manufacturing costs , product yields , headcount and cost-reduction strategies . we expect our gross loss to reduce and become gross profit over the long term as our production volume increases and certain costs remain fixed or increase at a slower rate . we intend to use our design , engineering and manufacturing capabilities to further advance and improve the efficiency of our manufacturing processes , which we believe will reduce costs . story_separator_special_tag ; the emergence of competing or complementary technologies ; the number and types of future products we develop and commercialize ; 95 the costs of preparing , filing and prosecuting patent applications and maintaining , enforcing and defending intellectual property-related claims ; and the level of our selling , general and administrative expenses . although we bolstered our liquidity resources in 2020 , have an effective shelf registration statement and an “ at the market ” offering to allow us to raise additional capital when the opportunities permit , and may receive additional funds from the exercise of its warrants depending on market conditions , management concluded that the aforementioned conditions , including the ongoing uncertainty related to the negative impacts of the covid-19 pandemic , continue to raise substantial doubt about our ability to continue as a going concern within 12 months from the date of issuance of the financial statements . our plans to address this uncertainty include raising additional funding , if necessary , through public or private equity or debt financings . however , we may not be able to secure such financing in a timely manner or on favorable terms , if at all . furthermore , if we issue equity securities to raise additional funds , our existing stockholders may experience dilution , and the new equity securities may have rights , preferences and privileges senior to those of our existing stockholders . our financial statements include explanatory disclosures regarding substantial doubt about our ability to continue as a going concern . future reports on our financial statements may also include explanatory disclosures with respect to our ability to continue as a going concern . our financial statements do not include any adjustments relating to the recoverability and classification of recorded asset amounts or amounts of liabilities that might be necessary should we be unable to continue our operations . story_separator_special_tag normal ; letter-spacing:0pt ; font-family : times new roman ; font-size:10pt ; `` > determination of the transaction price ; allocation of the transaction price to the performance obligations in the contract ; and recognition of revenue when , or as , performance obligations are satisfied . we account for a contract with a customer when we have a legally enforceable contract with the customer , the arrangement identifies the rights of the parties , the contract has commercial substance , and we determine it is probable that it will collect the contract consideration . we recognize revenue when control of the promised goods or services transfers to customers , in an amount that reflects the consideration we expect to be entitled to in exchange for those goods or services . taxes collected from customers relating to goods or services and remitted to governmental authorities are excluded from revenue . catheter revenue we enter into a dabra laser commercial usage agreement or dabra laser placement acknowledgement with each customer that is supplied a dabra laser , collectively the “ usage agreement ” . the usage agreement provides for specific terms of continued use of dabra laser , including a nominal periodic fee . the terms of a usage agreement typically allow us to place a dabra laser at a customer 's specified location without a specified contract term . under the usage agreement terms , we retain all ownership rights to the dabra laser and are permitted to request the return of the equipment within 10 business days of notification . while the laser periodic fees are nominal , the laser usage agreements provide us the exclusive rights to supply related single-use catheters to the customer which aggregate the majority of the vascular segment revenue . there are no specified minimum purchase commitments for the catheters . we recognize revenue associated with the usage agreement and catheter supply arrangements in accordance with topic 606 as the contract primarily includes variable payments , the catheters are priced at their standalone selling price and the laser equipment is insignificant in the context of the contract . revenue is recognized when the performance obligation is satisfied , which is generally upon shipment of the catheter . laser sales sales of laser systems and are included in product sales in the statements of operations . we recognize revenue on laser sales at the point in time that control transfers to the customer . control of the product typically transfers upon shipment . warranty service revenue we typically provide a 12-month warranty with the purchase of our laser systems . customers can extend the warranty period through the purchase of extended warranty service contracts . extended warranty service contracts are sold with contract terms ranging from 12 to 60 months and cover periods after the end of the initial 12-month warranty period . the warranty provides the customer with maintenance services in addition to the assurance that the laser product complies with agreed-upon specifications . therefore , the warranty service is treated as a separate performance obligation from the laser system . warranty services are a stand-ready obligation , and we recognize revenue on a straight-line basis over the service contract term . warranty service revenue is included in service and other revenue in the statements of operations . 98 distributor transactions in certain markets outside the u.s. , we sell products and provide services to customers through distributors that specialize in medical device products . the terms of sales transactions through distributors are generally consistent with the terms of direct sales to customers . we account for these transactions in accordance with our revenue recognition policy described herein . contracts with multiple performance obligations certain of our contracts with customers contain multiple performance obligations . for these contracts , we account for individual products and services as separate performance obligations if they are distinct , which is if ( i ) a product or service is separately identifiable from other items in the arrangement and ( ii ) the customer can benefit from the product or service

cash flows replace_table_token_6_th net cash used in operating activities during the year ended december 31 , 2020 , net cash used in operating activities was $ 28.3 million , consisting primarily of a net loss of $ 36.0 million and a decrease in net operating assets of $ 1.0 million , partially offset by non-cash charges of $ 6.7 million consisting of primarily stock-based compensation expense and depreciation and amortization . during the year ended december 31 , 2019 , net cash used in operating activities was $ 33.2 million , consisting primarily of a net loss of $ 57.0 million and an increase in net operating assets of $ 1.9 million , partially offset by non-cash charges of $ 25.7 million consisting of primarily stock-based compensation expense , depreciation and amortization and allowance for doubtful accounts . net cash provided by ( used in ) investing activities during the year ended december 31 , 2020 , net cash provided by investing activities was $ 15.9 million , consisting of $ 16.0 million from proceeds of maturities of investments offset by $ 0.1 million in purchases of equipment . during the year ended december 31 , 2019 , net cash used in investing activities was $ 16.0 million , consisting of $ 36.5 million to purchase short-term investments and $ 0.3 million to purchase manufacturing equipment and vehicles for our sales force to transport our laser equipment , partially offset by $ 21.0 million from proceeds of sales of investments .


 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.
     ```cash flows replace_table_token_6_th net cash used in operating activities during the year ended december 31 , 2020 , net cash used in operating activities was $ 28.3 million , consisting primarily of a net loss of $ 36.0 million and a decrease in net operating assets of $ 1.0 million , partially offset by non-cash charges of $ 6.7 million consisting of primarily stock-based compensation expense and depreciation and amortization . during the year ended december 31 , 2019 , net cash used in operating activities was $ 33.2 million , consisting primarily of a net loss of $ 57.0 million and an increase in net operating assets of $ 1.9 million , partially offset by non-cash charges of $ 25.7 million consisting of primarily stock-based compensation expense , depreciation and amortization and allowance for doubtful accounts . net cash provided by ( used in ) investing activities during the year ended december 31 , 2020 , net cash provided by investing activities was $ 15.9 million , consisting of $ 16.0 million from proceeds of maturities of investments offset by $ 0.1 million in purchases of equipment . during the year ended december 31 , 2019 , net cash used in investing activities was $ 16.0 million , consisting of $ 36.5 million to purchase short-term investments and $ 0.3 million to purchase manufacturing equipment and vehicles for our sales force to transport our laser equipment , partially offset by $ 21.0 million from proceeds of sales of investments .
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 Suspicious Activity Report : our pharos laser is a medical device that we have marketed since october 2004 as a tool for the treatment of proliferative skin conditions including psoriasis , vitiligo , atopic dermatitis , and leukoderma . the covid-19 pandemic is negatively impacting the dermatology business as many customers delay the acquisition or purchase of capital equipment such as our pharos laser . because this business does not have a disposables component and we augment our capital equipment sales with recurring revenue derived from service and or rental or lease agreements , we are experiencing less of an impact than business models that rely solely on capital equipment and or disposables sales . we continue to evaluate our overall strategy for the dermatology business and believe there could be an opportunity to grow revenues and increase its cash contribution in the future . changes to our dermatology business strategy , as well as the timing of those potential changes , will be influenced by the continued impact of the covid-19 pandemic . recent developments covid-19 the global spread of the novel coronavirus ( covid-19 ) has created significant volatility , uncertainty and economic disruption . the ultimate effects of the covid-19 on our business , operations and financial condition are unknown at this time . in the near term , we expect that our revenue will continue to be adversely impacted and enrollment in our atherectomy clinical trial will continue to be delayed or slowed , as patients elect to postpone voluntary treatments and physicians ' offices are either closed or operating at a reduced capacity . in addition , some customers are requesting more flexible payment terms on a temporary basis . we also may not be able to secure additional financing in a timely manner or on favorable terms , if at all . our manufacturing facility located in carlsbad , california is currently operational . employee travel is limited to essential travel only and many employees are working from home when feasible . we have experienced minor delays in receiving shipments of parts , which has affected the timing of our key engineering efforts . to date , the shipment delays have not had a material impact on our ability to support our atherectomy indication trial . however , the extent to which covid-19 impacts our business will depend on future developments , which are highly uncertain and can not be predicted , including new information which may emerge concerning the severity of covid-19 and the actions to contain it or treat its impact , among others . reverse stock split on november 16 , 2020 , we filed a certificate of amendment to the certificate of incorporation with the secretary of state of the state of delaware to effect a reverse stock split of our common stock at a ratio of one-for-twenty-five , or the reverse stock split . the reverse stock split became effective as of 4:01 p.m. eastern time on november 16 , 2020 , and our common stock began trading on the new york stock exchange on a post-split basis on november 17 , 2020. unless otherwise noted , all share and per share numbers contained in this annual report are reflected on a post-split basis for all periods presented . nyse american on december 17 , 2020 , we received approval to list our common stock on the nyse american and provided written notice to the new york stock exchange , or the nyse , of our intention to list our common stock on nyse american and to simultaneously delist such securities from the nyse . our final day trading on the nyse was on december 21 , 2020 and we commenced trading on nyse american on december 22 , 2020 under our current stock symbol “ rmed . ” components of our results of operations net revenue product sales consist of the sale of dabra and pharos lasers , the sale of catheters for use with the dabra laser and the sale of consumables and replacement parts . 89 service and other revenue consists primarily of sales of extended warranties , which we recognize over the contract period and billable services , including repair activity , which is recognized when the service is provided . it also includes income from the rental of our lasers . we currently use our commercial team to service the u.s. market , and we utilize distributors outside the u.s. in markets where we have received regulatory approval . we expect to continue to seek regulatory approvals for our products in additional strategic markets . cost of revenue and gross profit ( loss ) cost of revenue for product sales consists primarily of costs of components for use in our products , the labor that are used to produce our products , and the manufacturing overhead that support production . cost of revenue for service and other includes the cost of maintaining and servicing the warranties on our products , including the depreciation on lasers we own . we expect cost of revenue to increase to the extent our total revenue grows . we calculate gross profit ( loss ) as revenue less cost of revenue . our gross profit ( loss ) has been and will continue to be affected by a variety of factors , primarily production volumes , the cost of direct materials , discounting practices , manufacturing costs , product yields , headcount and cost-reduction strategies . we expect our gross loss to reduce and become gross profit over the long term as our production volume increases and certain costs remain fixed or increase at a slower rate . we intend to use our design , engineering and manufacturing capabilities to further advance and improve the efficiency of our manufacturing processes , which we believe will reduce costs . story_separator_special_tag ; the emergence of competing or complementary technologies ; the number and types of future products we develop and commercialize ; 95 the costs of preparing , filing and prosecuting patent applications and maintaining , enforcing and defending intellectual property-related claims ; and the level of our selling , general and administrative expenses . although we bolstered our liquidity resources in 2020 , have an effective shelf registration statement and an “ at the market ” offering to allow us to raise additional capital when the opportunities permit , and may receive additional funds from the exercise of its warrants depending on market conditions , management concluded that the aforementioned conditions , including the ongoing uncertainty related to the negative impacts of the covid-19 pandemic , continue to raise substantial doubt about our ability to continue as a going concern within 12 months from the date of issuance of the financial statements . our plans to address this uncertainty include raising additional funding , if necessary , through public or private equity or debt financings . however , we may not be able to secure such financing in a timely manner or on favorable terms , if at all . furthermore , if we issue equity securities to raise additional funds , our existing stockholders may experience dilution , and the new equity securities may have rights , preferences and privileges senior to those of our existing stockholders . our financial statements include explanatory disclosures regarding substantial doubt about our ability to continue as a going concern . future reports on our financial statements may also include explanatory disclosures with respect to our ability to continue as a going concern . our financial statements do not include any adjustments relating to the recoverability and classification of recorded asset amounts or amounts of liabilities that might be necessary should we be unable to continue our operations . story_separator_special_tag normal ; letter-spacing:0pt ; font-family : times new roman ; font-size:10pt ; `` > determination of the transaction price ; allocation of the transaction price to the performance obligations in the contract ; and recognition of revenue when , or as , performance obligations are satisfied . we account for a contract with a customer when we have a legally enforceable contract with the customer , the arrangement identifies the rights of the parties , the contract has commercial substance , and we determine it is probable that it will collect the contract consideration . we recognize revenue when control of the promised goods or services transfers to customers , in an amount that reflects the consideration we expect to be entitled to in exchange for those goods or services . taxes collected from customers relating to goods or services and remitted to governmental authorities are excluded from revenue . catheter revenue we enter into a dabra laser commercial usage agreement or dabra laser placement acknowledgement with each customer that is supplied a dabra laser , collectively the “ usage agreement ” . the usage agreement provides for specific terms of continued use of dabra laser , including a nominal periodic fee . the terms of a usage agreement typically allow us to place a dabra laser at a customer 's specified location without a specified contract term . under the usage agreement terms , we retain all ownership rights to the dabra laser and are permitted to request the return of the equipment within 10 business days of notification . while the laser periodic fees are nominal , the laser usage agreements provide us the exclusive rights to supply related single-use catheters to the customer which aggregate the majority of the vascular segment revenue . there are no specified minimum purchase commitments for the catheters . we recognize revenue associated with the usage agreement and catheter supply arrangements in accordance with topic 606 as the contract primarily includes variable payments , the catheters are priced at their standalone selling price and the laser equipment is insignificant in the context of the contract . revenue is recognized when the performance obligation is satisfied , which is generally upon shipment of the catheter . laser sales sales of laser systems and are included in product sales in the statements of operations . we recognize revenue on laser sales at the point in time that control transfers to the customer . control of the product typically transfers upon shipment . warranty service revenue we typically provide a 12-month warranty with the purchase of our laser systems . customers can extend the warranty period through the purchase of extended warranty service contracts . extended warranty service contracts are sold with contract terms ranging from 12 to 60 months and cover periods after the end of the initial 12-month warranty period . the warranty provides the customer with maintenance services in addition to the assurance that the laser product complies with agreed-upon specifications . therefore , the warranty service is treated as a separate performance obligation from the laser system . warranty services are a stand-ready obligation , and we recognize revenue on a straight-line basis over the service contract term . warranty service revenue is included in service and other revenue in the statements of operations . 98 distributor transactions in certain markets outside the u.s. , we sell products and provide services to customers through distributors that specialize in medical device products . the terms of sales transactions through distributors are generally consistent with the terms of direct sales to customers . we account for these transactions in accordance with our revenue recognition policy described herein . contracts with multiple performance obligations certain of our contracts with customers contain multiple performance obligations . for these contracts , we account for individual products and services as separate performance obligations if they are distinct , which is if ( i ) a product or service is separately identifiable from other items in the arrangement and ( ii ) the customer can benefit from the product or service

