as of december 31 , 2020 , we had cash and cash equivalents of $ 287.5 million . based on our current operating plan , we believe that our existing cash and cash equivalents will be sufficient to meet our anticipated cash requirements into the fourth quarter of 2022. we do not have any products approved for sale and have incurred net losses since our inception . our net losses for the years ended december 31 , 2020 and 2019 were $ 129.1 million and $ 255.1 million , respectively . as of december 31 , 2020 , we had an accumulated deficit of $ 385.5 million . our net losses may fluctuate significantly from quarter-to-quarter and year-to-year , depending on the timing of our clinical development activities , other research and development activities and pre-commercialization activities . we expect our expenses and operating 109 losses will increase substantially as we advance vonoprazan through clinical trials , seek regulatory approval for vonoprazan , expand our clinical , regulatory , quality , manufacturing and commercialization capabilities , incur significant commercialization expenses for marketing , sales , manufacturing and distribution if we obtain marketing approval for vonoprazan , protect our intellectual property , expand our general and administrative support functions , including hiring additional personnel , and incur additional costs associated with operating as a public company . we have never generated any revenue and do not expect to generate any revenues from product sales unless and until we successfully complete development and obtain regulatory approval for vonoprazan , which will not be for several years , if ever . accordingly , until such time as we can generate significant revenue from sales of vonoprazan , if ever , we expect to finance our cash needs through equity offerings , our loan agreement , debt financings , or other capital sources , including potential collaborations , licenses and other similar arrangements . however , we may be unable to raise additional funds or enter into such other arrangements when needed on favorable terms or at all , and this risk could be exacerbated by the impact of covid-19 on global economic conditions . our failure to raise capital or enter into such other arrangements when needed would have a negative impact on our financial condition and could force us to delay , limit , reduce or terminate our product development or future commercialization efforts or grant rights to develop and market product candidates that we would otherwise prefer to develop and market ourselves . financial operations overview our financial statements include our accounts ( the receiving entity ) and the accounts of yamadaco iia , inc. , or yamadaco , prior to being merged into a single entity effective march 13 , 2019. we and yamadaco were entities under common control of frazier life sciences ix , l.p. , or frazier , as a result of , among other things , frazier 's : ( i ) ownership of a majority of the outstanding capital stock of both companies ; ( ii ) financing of both companies ; ( iii ) control of the board of directors of both companies ; and ( iv ) management of both companies . both phathom and yamadaco iia were formed for the purpose of identifying potential assets around which to form an operating company . as the merged entities were under common control , the financial statements report the financial position , results of operations and cash flows of phathom and yamadaco as though the transfer of net assets and equity interests had occurred at the beginning of 2018. all intercompany accounts and transactions have been eliminated . license agreement with takeda on may 7 , 2019 , we and takeda entered into the takeda license , pursuant to which we in-licensed the u.s. , european , and canadian rights to vonoprazan fumarate . during the term of the takeda license , we and our affiliates are not permitted to commercialize any pharmaceutical product , other than vonoprazan , that treats acid-related disorders , except for certain generic and otc competing products in specified circumstances . we will be responsible at our cost for the development , manufacture and commercialization of vonoprazan products . we are required to use commercially reasonable efforts to develop and commercialize the vonoprazan products in our licensed territory . under the takeda license , takeda has the sole right and authority , with our input , to prepare , file , prosecute , and maintain all takeda and joint patents on a worldwide basis at its own cost . we are responsible , at our cost , for preparing , filing , prosecuting , and maintaining patents on inventions made solely by us in connection with vonoprazan , subject to input from takeda . we paid takeda upfront consideration consisting of a cash fee of $ 25.0 million , 1,084,000 shares of our common stock , the takeda warrant to purchase 7,588,000 shares of our common stock at an exercise price of $ 0.00004613 per share , and issued takeda a right to receive an additional common stock warrant , or the takeda warrant right , if takeda 's fully-diluted ownership of the company represented less than a certain specified percentage of the fully-diluted capitalization , including shares issuable upon conversion of then outstanding convertible promissory notes , calculated immediately prior to the closing of our ipo . the takeda warrant right expired without effect since no fair value had been allocated to it upon completion of our ipo , and no additional warrant was issued . we agreed to make milestone payments to takeda upon achieving certain tiered aggregate annual net sales of licensed products in the united states , europe and canada up to a total maximum milestone amount of $ 250.0 million . story_separator_special_tag upon the term loan b draw in march 2020 , the put option related to the lender warrants expired , at which time we recorded a final fair value adjustment and reclassified the lender warrants balance of $ 0.3 million to additional paid-in-capital . 115 convertible note financings from january 2018 to april 2019 , we issued an aggregate of $ 2.4 million of convertible promissory notes to frazier , or the frazier notes , bearing interest at per annum rates ranging from 1.68 % to 2.55 % . in may 2019 , these notes and related accrued interest were exchanged , at their then fair value of $ 2.4 million , for the may 2019 convertible promissory notes described below . on may 7 , 2019 , we entered into a note purchase agreement under which we issued an aggregate of $ 90.3 million of unsecured convertible promissory notes , or the may 2019 notes , resulting in gross proceeds to us of $ 87.8 million in cash and $ 2.4 million related to the exchange of the frazier notes . including the conversion of the frazier notes , frazier purchased $ 20.0 million of the may 2019 notes . the may 2019 notes bore interest at a rate of 6 % per annum and were subordinated to borrowings under our loan agreement . immediately prior to the completion of our ipo on october 29 , 2019 , the may 2019 notes automatically converted into 6,107,918 shares of common stock , representing the outstanding principal and interest of the may 2019 notes at the date of automatic conversion . at-the-market-offering on november 10 , 2020 , we entered into an open market sale agreement sm , or the sales agreement , with jefferies llc , or the sales agent , under which we may , from time to time , sell shares of our common stock having an aggregate offering price of up to $ 125.0 million through the sales agent , or the atm offering . sales of our common stock made pursuant to the sales agreement , if any , will be made under our shelf registration statement on form s-3 which was filed on november 10 , 2020 and declared effective by the sec on november 16 , 2020. we are not obligated to , and we can not provide any assurances that we will , make any sales of the shares under the sales agreement . the sales agreement may be terminated by the sales agent or us at any time . there were no sales of our common stock under the atm offering for the year ended december 31 , 2020. underwritten public offering on december 16 , 2020 , the company completed an underwritten public offering , in which it sold 2,250,000 shares of its common stock at a price of $ 42.00 per share for total gross proceeds of $ 94.5 million . the net purchase price after deducting underwriting discounts and commissions was $ 39.48 per share , which generated net proceeds of $ 88.8 million . we incurred an additional $ 0.2 million of offering expenses in connection with the public offering . funding requirements based on our current operating plan , we believe that our existing cash and cash equivalents will be sufficient to meet our anticipated cash requirements into the fourth quarter of 2022. we expect our current cash and cash equivalents will allow us to complete our ongoing phase 3 clinical trials of vonoprazan for the treatment of erosive esophagitis and h. pylori infection and our planned phase 2 trial of vonoprazan as an on-demand therapy for nerd . however , our forecast of the period of time through which our financial resources will be adequate to support our operations is a forward-looking statement that involves risks and uncertainties , and actual results could vary materially . we have based this estimate on assumptions that may prove to be wrong , and we could deplete our capital resources sooner than we expect . additionally , the process of testing product candidates in clinical trials is costly , and the timing of progress and expenses in these trials is uncertain . our future capital requirements will depend on many factors , including : the initiation , type , number , scope , results , costs and timing of our clinical trials of vonoprazan , and preclinical studies or clinical trials of other potential product candidates we may choose to pursue in the future , including feedback received from regulatory authorities ; delays and cost increases as a result of covid-19 ; the costs and timing of manufacturing for vonoprazan or any future product candidates , including commercial scale manufacturing if any product candidate is approved ; the costs , timing and outcome of regulatory review of vonoprazan or any future product candidates ; 116 the costs of obtaining , maintaining and enforcing our patents and other intellectual property rights ; our efforts to enhance operational systems and hire additional personnel to satisfy our obligations as a public company , including enhanced internal controls over financial reporting ; the costs associated with hiring additional personnel and consultants as our business grows , including additional executive officers and clinical development personnel ; the timing and amount of the milestone or other payments we must make to takeda and any future licensors ; the costs and timing of establishing or securing sales and marketing capabilities for vonoprazan or any future product candidate ; our ability to achieve sufficient market acceptance , coverage and adequate reimbursement from third-party payors and adequate market share and revenue for any approved products ; patients ' willingness to pay out-of-pocket for any approved products in the absence of coverage and or adequate reimbursement from third-party payors ; the terms and timing of establishing and maintaining collaborations , licenses and other similar arrangements ; and costs associated with any products or technologies that we may in-license or

cash flows the following table sets forth a summary of the net cash flow activity for each of the periods indicated ( in thousands ) : replace_table_token_4_th operating activities net cash used in operating activities was approximately $ 69.7 million and $ 36.5 million for the years ended december 31 , 2020 and 2019 , respectively . the net cash used in operating activities for the year ended december 31 , 2020 was due to approximately $ 121.4 million spent on ongoing research and development and general and administrative activities , partially offset by a $ 51.7 million net change in operating assets and liabilities . the net change in operating assets and liabilities primarily related to a $ 8.0 million decrease in prepaid clinical activities , and a $ 43.9 million increase in accounts payable and accrued expenses in support of the growth in our operating activities , partially offset by a $ 0.2 million increase in other long-term assets . the net cash used in operating activities for the year ended december 31 , 2019 was due to approximately $ 27.0 million spent on ongoing research and development and general and administrative expenses and $ 9.5 million net change in operating assets and liabilities .


 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 the following table sets forth a summary of the net cash flow activity for each of the periods indicated ( in thousands ) : replace_table_token_4_th operating activities net cash used in operating activities was approximately $ 69.7 million and $ 36.5 million for the years ended december 31 , 2020 and 2019 , respectively . the net cash used in operating activities for the year ended december 31 , 2020 was due to approximately $ 121.4 million spent on ongoing research and development and general and administrative activities , partially offset by a $ 51.7 million net change in operating assets and liabilities . the net change in operating assets and liabilities primarily related to a $ 8.0 million decrease in prepaid clinical activities , and a $ 43.9 million increase in accounts payable and accrued expenses in support of the growth in our operating activities , partially offset by a $ 0.2 million increase in other long-term assets . the net cash used in operating activities for the year ended december 31 , 2019 was due to approximately $ 27.0 million spent on ongoing research and development and general and administrative expenses and $ 9.5 million net change in operating assets and liabilities .
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 Suspicious Activity Report : as of december 31 , 2020 , we had cash and cash equivalents of $ 287.5 million . based on our current operating plan , we believe that our existing cash and cash equivalents will be sufficient to meet our anticipated cash requirements into the fourth quarter of 2022. we do not have any products approved for sale and have incurred net losses since our inception . our net losses for the years ended december 31 , 2020 and 2019 were $ 129.1 million and $ 255.1 million , respectively . as of december 31 , 2020 , we had an accumulated deficit of $ 385.5 million . our net losses may fluctuate significantly from quarter-to-quarter and year-to-year , depending on the timing of our clinical development activities , other research and development activities and pre-commercialization activities . we expect our expenses and operating 109 losses will increase substantially as we advance vonoprazan through clinical trials , seek regulatory approval for vonoprazan , expand our clinical , regulatory , quality , manufacturing and commercialization capabilities , incur significant commercialization expenses for marketing , sales , manufacturing and distribution if we obtain marketing approval for vonoprazan , protect our intellectual property , expand our general and administrative support functions , including hiring additional personnel , and incur additional costs associated with operating as a public company . we have never generated any revenue and do not expect to generate any revenues from product sales unless and until we successfully complete development and obtain regulatory approval for vonoprazan , which will not be for several years , if ever . accordingly , until such time as we can generate significant revenue from sales of vonoprazan , if ever , we expect to finance our cash needs through equity offerings , our loan agreement , debt financings , or other capital sources , including potential collaborations , licenses and other similar arrangements . however , we may be unable to raise additional funds or enter into such other arrangements when needed on favorable terms or at all , and this risk could be exacerbated by the impact of covid-19 on global economic conditions . our failure to raise capital or enter into such other arrangements when needed would have a negative impact on our financial condition and could force us to delay , limit , reduce or terminate our product development or future commercialization efforts or grant rights to develop and market product candidates that we would otherwise prefer to develop and market ourselves . financial operations overview our financial statements include our accounts ( the receiving entity ) and the accounts of yamadaco iia , inc. , or yamadaco , prior to being merged into a single entity effective march 13 , 2019. we and yamadaco were entities under common control of frazier life sciences ix , l.p. , or frazier , as a result of , among other things , frazier 's : ( i ) ownership of a majority of the outstanding capital stock of both companies ; ( ii ) financing of both companies ; ( iii ) control of the board of directors of both companies ; and ( iv ) management of both companies . both phathom and yamadaco iia were formed for the purpose of identifying potential assets around which to form an operating company . as the merged entities were under common control , the financial statements report the financial position , results of operations and cash flows of phathom and yamadaco as though the transfer of net assets and equity interests had occurred at the beginning of 2018. all intercompany accounts and transactions have been eliminated . license agreement with takeda on may 7 , 2019 , we and takeda entered into the takeda license , pursuant to which we in-licensed the u.s. , european , and canadian rights to vonoprazan fumarate . during the term of the takeda license , we and our affiliates are not permitted to commercialize any pharmaceutical product , other than vonoprazan , that treats acid-related disorders , except for certain generic and otc competing products in specified circumstances . we will be responsible at our cost for the development , manufacture and commercialization of vonoprazan products . we are required to use commercially reasonable efforts to develop and commercialize the vonoprazan products in our licensed territory . under the takeda license , takeda has the sole right and authority , with our input , to prepare , file , prosecute , and maintain all takeda and joint patents on a worldwide basis at its own cost . we are responsible , at our cost , for preparing , filing , prosecuting , and maintaining patents on inventions made solely by us in connection with vonoprazan , subject to input from takeda . we paid takeda upfront consideration consisting of a cash fee of $ 25.0 million , 1,084,000 shares of our common stock , the takeda warrant to purchase 7,588,000 shares of our common stock at an exercise price of $ 0.00004613 per share , and issued takeda a right to receive an additional common stock warrant , or the takeda warrant right , if takeda 's fully-diluted ownership of the company represented less than a certain specified percentage of the fully-diluted capitalization , including shares issuable upon conversion of then outstanding convertible promissory notes , calculated immediately prior to the closing of our ipo . the takeda warrant right expired without effect since no fair value had been allocated to it upon completion of our ipo , and no additional warrant was issued . we agreed to make milestone payments to takeda upon achieving certain tiered aggregate annual net sales of licensed products in the united states , europe and canada up to a total maximum milestone amount of $ 250.0 million . story_separator_special_tag upon the term loan b draw in march 2020 , the put option related to the lender warrants expired , at which time we recorded a final fair value adjustment and reclassified the lender warrants balance of $ 0.3 million to additional paid-in-capital . 115 convertible note financings from january 2018 to april 2019 , we issued an aggregate of $ 2.4 million of convertible promissory notes to frazier , or the frazier notes , bearing interest at per annum rates ranging from 1.68 % to 2.55 % . in may 2019 , these notes and related accrued interest were exchanged , at their then fair value of $ 2.4 million , for the may 2019 convertible promissory notes described below . on may 7 , 2019 , we entered into a note purchase agreement under which we issued an aggregate of $ 90.3 million of unsecured convertible promissory notes , or the may 2019 notes , resulting in gross proceeds to us of $ 87.8 million in cash and $ 2.4 million related to the exchange of the frazier notes . including the conversion of the frazier notes , frazier purchased $ 20.0 million of the may 2019 notes . the may 2019 notes bore interest at a rate of 6 % per annum and were subordinated to borrowings under our loan agreement . immediately prior to the completion of our ipo on october 29 , 2019 , the may 2019 notes automatically converted into 6,107,918 shares of common stock , representing the outstanding principal and interest of the may 2019 notes at the date of automatic conversion . at-the-market-offering on november 10 , 2020 , we entered into an open market sale agreement sm , or the sales agreement , with jefferies llc , or the sales agent , under which we may , from time to time , sell shares of our common stock having an aggregate offering price of up to $ 125.0 million through the sales agent , or the atm offering . sales of our common stock made pursuant to the sales agreement , if any , will be made under our shelf registration statement on form s-3 which was filed on november 10 , 2020 and declared effective by the sec on november 16 , 2020. we are not obligated to , and we can not provide any assurances that we will , make any sales of the shares under the sales agreement . the sales agreement may be terminated by the sales agent or us at any time . there were no sales of our common stock under the atm offering for the year ended december 31 , 2020. underwritten public offering on december 16 , 2020 , the company completed an underwritten public offering , in which it sold 2,250,000 shares of its common stock at a price of $ 42.00 per share for total gross proceeds of $ 94.5 million . the net purchase price after deducting underwriting discounts and commissions was $ 39.48 per share , which generated net proceeds of $ 88.8 million . we incurred an additional $ 0.2 million of offering expenses in connection with the public offering . funding requirements based on our current operating plan , we believe that our existing cash and cash equivalents will be sufficient to meet our anticipated cash requirements into the fourth quarter of 2022. we expect our current cash and cash equivalents will allow us to complete our ongoing phase 3 clinical trials of vonoprazan for the treatment of erosive esophagitis and h. pylori infection and our planned phase 2 trial of vonoprazan as an on-demand therapy for nerd . however , our forecast of the period of time through which our financial resources will be adequate to support our operations is a forward-looking statement that involves risks and uncertainties , and actual results could vary materially . we have based this estimate on assumptions that may prove to be wrong , and we could deplete our capital resources sooner than we expect . additionally , the process of testing product candidates in clinical trials is costly , and the timing of progress and expenses in these trials is uncertain . our future capital requirements will depend on many factors , including : the initiation , type , number , scope , results , costs and timing of our clinical trials of vonoprazan , and preclinical studies or clinical trials of other potential product candidates we may choose to pursue in the future , including feedback received from regulatory authorities ; delays and cost increases as a result of covid-19 ; the costs and timing of manufacturing for vonoprazan or any future product candidates , including commercial scale manufacturing if any product candidate is approved ; the costs , timing and outcome of regulatory review of vonoprazan or any future product candidates ; 116 the costs of obtaining , maintaining and enforcing our patents and other intellectual property rights ; our efforts to enhance operational systems and hire additional personnel to satisfy our obligations as a public company , including enhanced internal controls over financial reporting ; the costs associated with hiring additional personnel and consultants as our business grows , including additional executive officers and clinical development personnel ; the timing and amount of the milestone or other payments we must make to takeda and any future licensors ; the costs and timing of establishing or securing sales and marketing capabilities for vonoprazan or any future product candidate ; our ability to achieve sufficient market acceptance , coverage and adequate reimbursement from third-party payors and adequate market share and revenue for any approved products ; patients ' willingness to pay out-of-pocket for any approved products in the absence of coverage and or adequate reimbursement from third-party payors ; the terms and timing of establishing and maintaining collaborations , licenses and other similar arrangements ; and costs associated with any products or technologies that we may in-license or

