based upon the levels of inventory we were carrying before the medical device excise tax was effective , we did not recognize any of the excise tax until the fourth quarter of 2013. the excise tax is derived from a constructive sales price , as defined by u.s. tax law and internal revenue service ( irs ) guidance . prior to the medical device excise tax effective date , the irs issued interim rules ( see irs notice 2012-77 ) that provide , among other things , that medical device manufacturers selling to an affiliated distribution entity may apply a 28.75 % discount off retail selling prices when computing the tax base . we are in discussions with the irs as to what an appropriate constructive sales price should be under irs excise tax regulations and our specific business model . as a result of our discussions with the irs , our ultimate medical device excise tax may differ from the amount determined under notice 2012-77. we estimate the cost in 2014 will be approximately $ 10 million per quarter . since we recognize the medical device excise tax as a part of the cost of inventory , the amount expensed in any particular quarter will vary according to u.s. sales levels in that quarter . we expect to continue making investments in research and development ( r & d ) of between 4 and 4.5 percent of sales in 2014. selling , general and administrative expenses ( sg & a ) as a percentage of sales is expected to be between 38.5 and 39 percent in 2014 as we realize efficiencies from our quality and operational excellence initiatives and further leverage revenue growth . we expect to incur approximately $ 250 million of expenses in 2014 related to our quality and operational excellence initiatives and integration costs from recent acquisitions . the quality and operational excellence programs are intended to improve our future operating results and include centralizing or outsourcing certain functions and improving quality , distribution , sourcing , manufacturing and information technology systems . we expect to recognize the 18 zimmer holdings , inc. 2013 form 10-k annual report majority of these expenses in special items on our statement of earnings , but some will be related to inventory and be reflected in costs of products sold . assuming variable interest rates remain at december 31 , 2013 levels , we expect interest income and expense , net , to be similar to 2013. we expect our etr to increase in 2014 relative to 2013 , as we do not anticipate certain significant costs , such as excess and obsolete inventory charges and certain claims that were incurred in jurisdictions with higher tax rates , to recur , thus increasing the profit in those higher tax jurisdictions . based upon the above , we expect reported net earnings and diluted earnings per share to increase in a range of approximately 13 to 17 percent in 2014 relative to 2013 , stemming from anticipated higher sales and an improved gross margin . results of operations net sales by reportable segment the following tables present net sales by reportable segment and the components of the percentage changes ( dollars in millions ) : replace_table_token_3_th replace_table_token_4_th foreign exchange as used in the tables in this report represents the effect of changes in foreign currency exchange rates on sales growth . net sales by product category the following tables present net sales by product category and the components of the percentage changes ( dollars in millions ) : replace_table_token_5_th replace_table_token_6_th 19 zimmer holdings , inc. 2013 form 10-k annual report beginning in 2013 , our knees product category net sales include certain early intervention products that are primarily used in knee procedures . in 2012 and 2011 , these products were included in the surgical and other product category . net sales in the years ended december 31 , 2012 and 2011 related to these products have been reclassified to conform to the 2013 presentation . the following table presents net sales by product category by region ( dollars in millions ) : replace_table_token_7_th 20 zimmer holdings , inc. 2013 form 10-k annual report demand ( volume and mix ) trends increased volume and changes in the mix of product sales contributed 7 percentage points of year-over-year sales growth in 2013 , which is a higher growth rate than experienced in 2012 compared to 2011. in 2013 , accelerated growth was fueled by the introduction of new products , such as persona the personalized knee system and the transposal fluid waste management system . we believe procedure volumes in the broader musculoskeletal market remained stable or improved slightly in 2013 relative to 2012. we believe long-term indicators point toward sustained growth driven by an aging global population , growth in emerging markets , obesity , proven clinical benefits , new material technologies , advances in surgical techniques and more active lifestyles , among other factors . in addition , demand for clinically proven premium products and patient specific devices will continue to positively affect sales growth in markets that recognize the value in these advanced technologies . pricing trends global selling prices had a negative effect of 2 percent on year-over-year sales during 2013. our americas and europe reporting segments and certain countries in our asia pacific reporting segment continued to experience pricing pressure from governmental healthcare cost containment efforts and from local hospitals and health systems . for 2014 , we estimate that selling prices will decline slightly more than they did in 2013 due to a biennial price adjustment in japan in the second quarter of 2014 along with some moderately weaker pricing in europe . story_separator_special_tag while changes in foreign currency exchange rates decreased sales by 10 percent in 2013 compared to 2012 , this decline was largely offset by hedge gains recorded in 2013 versus hedge losses recorded in 2012. non-gaap operating performance measures we use financial measures that differ from financial measures determined in accordance with gaap to evaluate our operating performance . these non-gaap financial measures exclude the impact of inventory step-up , certain inventory and manufacturing related charges connected to quality enhancement and remediation efforts , inventory obsolescence charges associated with products we intend to discontinue , certain claims ,  special items ,  and any related effects on our income tax provision associated with these items in addition to certain other tax adjustments . we use this information internally and believe it is helpful to investors because it allows more meaningful period-to-period comparisons of our ongoing operating results , it helps to perform trend analysis and to better identify operating trends that may otherwise be masked or distorted by these types of items , and it provides a higher degree of transparency of certain items . certain of these non-gaap financial measures are used as metrics for our incentive compensation programs . our non-gaap adjusted net earnings used for internal management purposes for the years ended december 31 , 2013 , 2012 and 2011 were $ 988.4 million , $ 932.5 million , and $ 905.6 million , respectively , and our non-gaap adjusted diluted earnings per share were $ 5.75 , $ 5.30 , and $ 4.80 , respectively . the following are reconciliations from our gaap net earnings and diluted earnings per share to our non-gaap adjusted net earnings and non-gaap adjusted diluted earnings per share used for internal management purposes ( in millions , except per share amounts ) . replace_table_token_10_th * the tax effect is calculated based upon the statutory rates for the jurisdictions where the items were incurred . replace_table_token_11_th * the tax effect is calculated based upon the statutory rates for the jurisdictions where the items were incurred . story_separator_special_tag able to issue new senior notes , we intend to borrow against our senior credit facility to pay these notes . 25 zimmer holdings , inc. 2013 form 10-k annual report we have a five year $ 1,350 million revolving , multi-currency , senior unsecured credit facility maturing may 9 , 2017 ( senior credit facility ) . there were no borrowings outstanding under the senior credit facility at december 31 , 2013. we and certain of our wholly owned foreign subsidiaries are the borrowers under the senior credit facility . borrowings under the senior credit facility bear interest at a libor-based rate plus an applicable margin determined by reference to our senior unsecured long-term credit rating and the amounts drawn under the senior credit facility , at an alternate base rate , or at a fixed-rate determined through a competitive bid process . the senior credit facility contains customary affirmative and negative covenants and events of default for an unsecured financing arrangement , including , among other things , limitations on consolidations , mergers and sales or transfers of assets . financial covenants include a maximum leverage ratio of 3.0 to 1.0. if we fall below an investment grade credit rating , additional restrictions would result , including restrictions on investments , payment of dividends and stock repurchases . we were in compliance with all covenants under the senior credit facility as of december 31 , 2013. commitments under the senior credit facility are subject to certain fees , including a facility fee and a utilization fee . we have a term loan agreement ( term loan ) with one of the lenders under the senior credit facility for 11.7 billion japanese yen that will mature on may 31 , 2016. borrowings under the term loan bear interest at a fixed rate of 0.61 percent per annum until maturity . we also have available uncommitted credit facilities totaling $ 50.7 million . we place our cash and cash equivalents in highly-rated financial institutions and limit the amount of credit exposure to any one entity . we invest only in high-quality financial instruments in accordance with our internal investment policy . as of december 31 , 2013 , we had short-term and long-term investments in debt securities with a fair value of $ 807.7 million . these investments are in debt securities of many different issuers and therefore we believe we have no significant concentration of risk with a single issuer . all of these debt securities remain highly-rated and we believe the risk of default by the issuers is low . as of december 31 , 2013 , $ 891.9 million of our cash and cash equivalents and short-term and long-term investments were held in jurisdictions outside of the u.s. and are expected to be indefinitely reinvested for continued use in foreign operations . repatriation of these assets to the u.s. may have tax consequences . $ 478.8 million of this amount is denominated in u.s. dollars and therefore bears no foreign currency translation risk . the balance of these assets is denominated in currencies of the various countries where we operate . we may use excess cash to repurchase common stock under our share repurchase program . effective january 1 , 2014 , we have a new share repurchase program that authorizes purchases of up to $ 1.0 billion with no expiration date . no further purchases will be made under the previous share repurchase program . management believes that cash flows from operations and available borrowings under the senior credit facility or from the public and private debt markets are sufficient to meet our working capital , capital expenditure and debt service needs , as well as return cash to stockholders in the form of dividends and share repurchases . should investment opportunities arise , we believe that our earnings , balance sheet and cash flows will allow us to obtain

liquidity and capital resources cash flows provided by operating activities were $ 963.1 million in 2013 , compared to $ 1,151.9 million in 2012. the principal source of cash from operating activities in 2013 was net earnings . non-cash charges included in net earnings accounted for another $ 288.8 million of operating cash . all other items of operating cash flows in 2013 were outflows of $ 84.9 million of cash . the lower cash flows provided by operating activities in the 2013 period were primarily due to increases in inventory caused by the medical device excise tax and inventory investments to support new product launches . additionally , cash flows were unfavorable compared to the 24 zimmer holdings , inc. 2013 form 10-k annual report prior year due to spending on our quality and operational excellence initiatives . these unfavorable items were partially offset by lower product liability payments for durom cup claims , and lower funding required on our u.s. pension plans for 2013. at december 31 , 2013 , we had 65 days of sales outstanding in trade accounts receivable , which was higher by one day compared to december 31 , 2012. at december 31 , 2013 , we had 285 days of inventory on hand , a decrease of 16 days compared to december 31 , 2012. we consider the changes in days of sales outstanding and days of inventory on hand as normal fluctuations for our business . cash flows used in investing activities were $ 282.5 million in 2013 , compared to $ 592.1 million in 2012. additions to instruments increased in 2013 due to purchases for significant product launches , such as persona the personalized knee system . spending on other property , plant and equipment was relatively consistent in 2013 relative to 2012 , reflecting cash outlays necessary to complete new product-related investments and replace older machinery and equipment . in 2014 , instrument additions are expected to be in a range of $ 200 to $ 210 million as part of our ongoing launch of persona the personalized knee system .


 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 cash flows provided by operating activities were $ 963.1 million in 2013 , compared to $ 1,151.9 million in 2012. the principal source of cash from operating activities in 2013 was net earnings . non-cash charges included in net earnings accounted for another $ 288.8 million of operating cash . all other items of operating cash flows in 2013 were outflows of $ 84.9 million of cash . the lower cash flows provided by operating activities in the 2013 period were primarily due to increases in inventory caused by the medical device excise tax and inventory investments to support new product launches . additionally , cash flows were unfavorable compared to the 24 zimmer holdings , inc. 2013 form 10-k annual report prior year due to spending on our quality and operational excellence initiatives . these unfavorable items were partially offset by lower product liability payments for durom cup claims , and lower funding required on our u.s. pension plans for 2013. at december 31 , 2013 , we had 65 days of sales outstanding in trade accounts receivable , which was higher by one day compared to december 31 , 2012. at december 31 , 2013 , we had 285 days of inventory on hand , a decrease of 16 days compared to december 31 , 2012. we consider the changes in days of sales outstanding and days of inventory on hand as normal fluctuations for our business . cash flows used in investing activities were $ 282.5 million in 2013 , compared to $ 592.1 million in 2012. additions to instruments increased in 2013 due to purchases for significant product launches , such as persona the personalized knee system . spending on other property , plant and equipment was relatively consistent in 2013 relative to 2012 , reflecting cash outlays necessary to complete new product-related investments and replace older machinery and equipment . in 2014 , instrument additions are expected to be in a range of $ 200 to $ 210 million as part of our ongoing launch of persona the personalized knee system .
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 Suspicious Activity Report : based upon the levels of inventory we were carrying before the medical device excise tax was effective , we did not recognize any of the excise tax until the fourth quarter of 2013. the excise tax is derived from a constructive sales price , as defined by u.s. tax law and internal revenue service ( irs ) guidance . prior to the medical device excise tax effective date , the irs issued interim rules ( see irs notice 2012-77 ) that provide , among other things , that medical device manufacturers selling to an affiliated distribution entity may apply a 28.75 % discount off retail selling prices when computing the tax base . we are in discussions with the irs as to what an appropriate constructive sales price should be under irs excise tax regulations and our specific business model . as a result of our discussions with the irs , our ultimate medical device excise tax may differ from the amount determined under notice 2012-77. we estimate the cost in 2014 will be approximately $ 10 million per quarter . since we recognize the medical device excise tax as a part of the cost of inventory , the amount expensed in any particular quarter will vary according to u.s. sales levels in that quarter . we expect to continue making investments in research and development ( r & d ) of between 4 and 4.5 percent of sales in 2014. selling , general and administrative expenses ( sg & a ) as a percentage of sales is expected to be between 38.5 and 39 percent in 2014 as we realize efficiencies from our quality and operational excellence initiatives and further leverage revenue growth . we expect to incur approximately $ 250 million of expenses in 2014 related to our quality and operational excellence initiatives and integration costs from recent acquisitions . the quality and operational excellence programs are intended to improve our future operating results and include centralizing or outsourcing certain functions and improving quality , distribution , sourcing , manufacturing and information technology systems . we expect to recognize the 18 zimmer holdings , inc. 2013 form 10-k annual report majority of these expenses in special items on our statement of earnings , but some will be related to inventory and be reflected in costs of products sold . assuming variable interest rates remain at december 31 , 2013 levels , we expect interest income and expense , net , to be similar to 2013. we expect our etr to increase in 2014 relative to 2013 , as we do not anticipate certain significant costs , such as excess and obsolete inventory charges and certain claims that were incurred in jurisdictions with higher tax rates , to recur , thus increasing the profit in those higher tax jurisdictions . based upon the above , we expect reported net earnings and diluted earnings per share to increase in a range of approximately 13 to 17 percent in 2014 relative to 2013 , stemming from anticipated higher sales and an improved gross margin . results of operations net sales by reportable segment the following tables present net sales by reportable segment and the components of the percentage changes ( dollars in millions ) : replace_table_token_3_th replace_table_token_4_th foreign exchange as used in the tables in this report represents the effect of changes in foreign currency exchange rates on sales growth . net sales by product category the following tables present net sales by product category and the components of the percentage changes ( dollars in millions ) : replace_table_token_5_th replace_table_token_6_th 19 zimmer holdings , inc. 2013 form 10-k annual report beginning in 2013 , our knees product category net sales include certain early intervention products that are primarily used in knee procedures . in 2012 and 2011 , these products were included in the surgical and other product category . net sales in the years ended december 31 , 2012 and 2011 related to these products have been reclassified to conform to the 2013 presentation . the following table presents net sales by product category by region ( dollars in millions ) : replace_table_token_7_th 20 zimmer holdings , inc. 2013 form 10-k annual report demand ( volume and mix ) trends increased volume and changes in the mix of product sales contributed 7 percentage points of year-over-year sales growth in 2013 , which is a higher growth rate than experienced in 2012 compared to 2011. in 2013 , accelerated growth was fueled by the introduction of new products , such as persona the personalized knee system and the transposal fluid waste management system . we believe procedure volumes in the broader musculoskeletal market remained stable or improved slightly in 2013 relative to 2012. we believe long-term indicators point toward sustained growth driven by an aging global population , growth in emerging markets , obesity , proven clinical benefits , new material technologies , advances in surgical techniques and more active lifestyles , among other factors . in addition , demand for clinically proven premium products and patient specific devices will continue to positively affect sales growth in markets that recognize the value in these advanced technologies . pricing trends global selling prices had a negative effect of 2 percent on year-over-year sales during 2013. our americas and europe reporting segments and certain countries in our asia pacific reporting segment continued to experience pricing pressure from governmental healthcare cost containment efforts and from local hospitals and health systems . for 2014 , we estimate that selling prices will decline slightly more than they did in 2013 due to a biennial price adjustment in japan in the second quarter of 2014 along with some moderately weaker pricing in europe . story_separator_special_tag while changes in foreign currency exchange rates decreased sales by 10 percent in 2013 compared to 2012 , this decline was largely offset by hedge gains recorded in 2013 versus hedge losses recorded in 2012. non-gaap operating performance measures we use financial measures that differ from financial measures determined in accordance with gaap to evaluate our operating performance . these non-gaap financial measures exclude the impact of inventory step-up , certain inventory and manufacturing related charges connected to quality enhancement and remediation efforts , inventory obsolescence charges associated with products we intend to discontinue , certain claims ,  special items ,  and any related effects on our income tax provision associated with these items in addition to certain other tax adjustments . we use this information internally and believe it is helpful to investors because it allows more meaningful period-to-period comparisons of our ongoing operating results , it helps to perform trend analysis and to better identify operating trends that may otherwise be masked or distorted by these types of items , and it provides a higher degree of transparency of certain items . certain of these non-gaap financial measures are used as metrics for our incentive compensation programs . our non-gaap adjusted net earnings used for internal management purposes for the years ended december 31 , 2013 , 2012 and 2011 were $ 988.4 million , $ 932.5 million , and $ 905.6 million , respectively , and our non-gaap adjusted diluted earnings per share were $ 5.75 , $ 5.30 , and $ 4.80 , respectively . the following are reconciliations from our gaap net earnings and diluted earnings per share to our non-gaap adjusted net earnings and non-gaap adjusted diluted earnings per share used for internal management purposes ( in millions , except per share amounts ) . replace_table_token_10_th * the tax effect is calculated based upon the statutory rates for the jurisdictions where the items were incurred . replace_table_token_11_th * the tax effect is calculated based upon the statutory rates for the jurisdictions where the items were incurred . story_separator_special_tag able to issue new senior notes , we intend to borrow against our senior credit facility to pay these notes . 25 zimmer holdings , inc. 2013 form 10-k annual report we have a five year $ 1,350 million revolving , multi-currency , senior unsecured credit facility maturing may 9 , 2017 ( senior credit facility ) . there were no borrowings outstanding under the senior credit facility at december 31 , 2013. we and certain of our wholly owned foreign subsidiaries are the borrowers under the senior credit facility . borrowings under the senior credit facility bear interest at a libor-based rate plus an applicable margin determined by reference to our senior unsecured long-term credit rating and the amounts drawn under the senior credit facility , at an alternate base rate , or at a fixed-rate determined through a competitive bid process . the senior credit facility contains customary affirmative and negative covenants and events of default for an unsecured financing arrangement , including , among other things , limitations on consolidations , mergers and sales or transfers of assets . financial covenants include a maximum leverage ratio of 3.0 to 1.0. if we fall below an investment grade credit rating , additional restrictions would result , including restrictions on investments , payment of dividends and stock repurchases . we were in compliance with all covenants under the senior credit facility as of december 31 , 2013. commitments under the senior credit facility are subject to certain fees , including a facility fee and a utilization fee . we have a term loan agreement ( term loan ) with one of the lenders under the senior credit facility for 11.7 billion japanese yen that will mature on may 31 , 2016. borrowings under the term loan bear interest at a fixed rate of 0.61 percent per annum until maturity . we also have available uncommitted credit facilities totaling $ 50.7 million . we place our cash and cash equivalents in highly-rated financial institutions and limit the amount of credit exposure to any one entity . we invest only in high-quality financial instruments in accordance with our internal investment policy . as of december 31 , 2013 , we had short-term and long-term investments in debt securities with a fair value of $ 807.7 million . these investments are in debt securities of many different issuers and therefore we believe we have no significant concentration of risk with a single issuer . all of these debt securities remain highly-rated and we believe the risk of default by the issuers is low . as of december 31 , 2013 , $ 891.9 million of our cash and cash equivalents and short-term and long-term investments were held in jurisdictions outside of the u.s. and are expected to be indefinitely reinvested for continued use in foreign operations . repatriation of these assets to the u.s. may have tax consequences . $ 478.8 million of this amount is denominated in u.s. dollars and therefore bears no foreign currency translation risk . the balance of these assets is denominated in currencies of the various countries where we operate . we may use excess cash to repurchase common stock under our share repurchase program . effective january 1 , 2014 , we have a new share repurchase program that authorizes purchases of up to $ 1.0 billion with no expiration date . no further purchases will be made under the previous share repurchase program . management believes that cash flows from operations and available borrowings under the senior credit facility or from the public and private debt markets are sufficient to meet our working capital , capital expenditure and debt service needs , as well as return cash to stockholders in the form of dividends and share repurchases . should investment opportunities arise , we believe that our earnings , balance sheet and cash flows will allow us to obtain

