most large insurers have established coverage policies in place to cover snm therapy . certain commercial payors have a patient-by-patient prior authorization process that must be followed before they will provide reimbursement for snm therapy . outside the united states , reimbursement levels vary significantly by country and by region , particularly based on whether the country or region at issue maintains a single-payor system . snm therapy is eligible for reimbursement in canada , australia , and certain countries in europe , such as germany , france , and the united kingdom . annual healthcare budgets generally determine the number of snm systems that will be paid for by the payor in these single-payor system countries and regions . we currently outsource the manufacture of the implantable components of our r-snm system . we plan to continue with an outsourced manufacturing arrangement for the foreseeable future . our contract manufacturers are all recognized in their field for their competency to manufacture the respective portions of our r-snm system and have quality systems established that meet fda requirements . we believe the manufacturers we currently utilize have sufficient capacity to meet our launch requirements and are able to scale up their capacity relatively quickly with limited capital investment . 76 prior to obtaining fda approval , we devoted substantially all of our resources to research and development activities related to our r-snm system , including clinical and regulatory initiatives to obtain marketing approvals . we expect to spend a significant amount of our resources on sales and marketing activities as we begin to commercialize and market our r-snm system in the united states . we incurred net losses of $ 79.9 million and $ 32.5 million for the years ended december 31 , 2019 and 2018 , and had an accumulated deficit of $ 179.6 million as of december 31 , 2019 compared to $ 99.6 million at december 31 , 2018 . as of december 31 , 2019 , we had available cash , cash equivalents and short-term investments of approximately $ 183.7 million , current liabilities of approximately $ 12.0 million , and long-term liabilities of approximately $ 24.8 million . prior to our ipo , we financed our operations primarily through preferred stock financings and amounts borrowed under the loan agreement . we have invested heavily in product development and continuous improvement to our r-snm system . we have also made significant investments in clinical studies to demonstrate the safety and effectiveness of our r-snm system and to support regulatory submissions . because of these and other factors , we expect to continue to incur net losses for the next few years and we may require additional funding , which may include future equity and debt financings . adequate funding may not be available to us on acceptable terms , or at all . our failure to obtain sufficient funds on acceptable terms when needed could have a material and adverse effect on our business , financial condition , and results of operations . initial public offering on november 2 , 2018 , we completed our ipo by issuing 9,200,000 shares of common stock , at an offering price of $ 15.00 per share , inclusive of 1,200,000 shares of our common stock issued upon the exercise by the underwriters of their option to purchase additional shares . the gross proceeds from the ipo were $ 138.0 million and the net proceeds were approximately $ 126.0 million , after deducting underwriting discounts , commissions and estimated offering expenses payable by us . in connection with the ipo , our outstanding shares of convertible preferred stock were automatically converted into an aggregate of 15,813,297 shares of common stock , and our outstanding warrants to purchase shares of series c convertible preferred stock were automatically converted into warrants to purchase up to an aggregate of 80,000 shares of common stock . follow-on offering on november 22 , 2019 , we completed a follow-on offering by issuing 5,345,000 shares of common stock , at an offering price of $ 22.00 per share , inclusive of 750,000 shares of our common stock issued upon the exercise by the underwriters of their option to purchase additional shares . the gross proceeds to us from this follow-on offering were $ 117.6 million and the net proceeds were approximately $ 110.4 million , after deducting underwriting discounts , commissions and estimated offering expenses payable by us . amf license agreement on october 1 , 2013 , we entered into the license agreement , pursuant to which amf granted us a royalty-bearing , sublicensable license to the amf ip . the license to the amf ip allows us to make , have made , lease , offer to lease , use , sell , offer for sale , market , promote , advertise , import , research , develop and commercialize the amf licensed products worldwide for the treatment of ( i ) chronic pain in humans through the application of electrical energy to the nervous system , ( ii ) inflammatory conditions of the human body through the application of electrical energy to the vagus nerve , a nerve that interfaces with parasympathic control of the heart , lungs and digestive tract and ( iii ) bladder and bowel dysfunction in humans through the application of electrical energy anywhere in or on the human body , excluding , in each case , any product or method that involves the placement of electrodes or the administration of electrical stimulation inside the cranial cavity or to the ocular nervous system or the auditory nervous system . we have the right to expand the field of use for the amf licensed products to the modulation of digestive process and treatment of digestive conditions in humans through the application of electrical energy anywhere in or on the body , subject to the exclusions described above . story_separator_special_tag net cash provided by ( used in ) investing activities net cash provided by investing activities was $ 45.3 million in fiscal year 2019 and consisted primarily of sales and maturities of short-term investments , partially offset by purchases of short-term investments . net cash used in investing activities was $ 60.1 million in fiscal year 2018 and consisted primarily of purchases and sales of short-term investments . 83 net cash provided by financing activities net cash provided by financing activities was $ 111.0 million in fiscal year 2019 and consisted primarily of $ 110.4 million in net proceeds received in the follow-on offering . net cash provided by financing activities was $ 165.3 million in fiscal year 2018 and consisted primarily of $ 126.0 million in net proceeds received in the ipo , $ 20.0 million of proceeds from our term loan with silicon valley bank , and $ 20.1 million of proceeds from the issuance of shares of our series c preferred stock . indebtedness in february 2018 , we entered into a loan and security agreement with silicon valley bank , which we and silicon valley bank amended in october 2018 and in december 2019 , providing for the term loan . pursuant to the loan agreement , we have drawn $ 20.0 million in three tranches of term loans , with such drawn obligations maturing on december 1 , 2021. the loan agreement provides for monthly interest payments but no principal amortization through december 31 , 2020. on the first day of the end of the interest only period , we will be required to repay the term loan in equal monthly installments of principal plus interest through maturity . outstanding principal balances under the term loan bear interest at the prime rate plus 1.75 % . we may prepay amounts outstanding under the term loan in increments of $ 5.0 million at any time with 30 days prior written notice to silicon valley bank . however , all prepayments of the term loan prior to maturity , whether voluntary or mandatory ( acceleration or otherwise ) , are also subject to the payment of a prepayment fee equal to ( i ) for a prepayment made on or after the closing date through and including the first anniversary of the closing date , 3.00 % of the principal amount of the term loan being prepaid , ( ii ) for a prepayment made after the date which is the first anniversary of the closing date through and including the second anniversary of the closing date , 2.00 % of the principal amount of the term loan being prepaid , and ( iii ) for a prepayment made after the date which is the second anniversary of the closing date and before the maturity date , 1.00 % of the principal amount of the term loan being prepaid . additionally , on the earliest to occur of ( i ) the maturity date of the term loan , ( ii ) the acceleration of the term loan , or ( iii ) the prepayment of the term loan , we will be required to make a final payment equal to the original principal amount of such tranche multiplied by 7.50 % . we are currently accruing the portion of the final payment calculated based on the amount outstanding under the term loan . all obligations under the term loan are secured by a first priority lien on substantially all of our assets , excluding intellectual property assets and more than 65 % of the shares of voting capital stock of any of our foreign subsidiaries . we have agreed with silicon valley bank not to encumber our intellectual property assets without its prior written consent unless a security interest in the underlying intellectual property is necessary to have a security interest in the accounts and proceeds that are part of the assets securing the term loan , in which case our intellectual property shall automatically be included within the assets securing the term loan . the loan agreement contains certain covenants that limit our ability to engage in certain transactions that may be in our long-term best interest . subject to certain limited exceptions , these covenants limit our ability to or prohibit us to permit any of our subsidiaries to , as applicable , among other things : pay cash dividends on , make any other distributions in respect of , or redeem , retire or repurchase , any shares of our capital stock ; convey , sell , lease , transfer , assign , or otherwise dispose of all or any part of our business or property ; effect certain changes in our business , management , ownership or business locations ; merge or consolidate with , or acquire all or substantially all of the capital stock or property of any other company ; create , incur , assume , or be liable for any additional indebtedness , or create , incur , allow , or permit to exist any additional liens ; make certain investments ; and enter into transactions with our affiliates . 84 as of december 31 , 2019 , we were in compliance with all debt covenant requirements under the term loan . while we have not previously breached and are currently in compliance with the covenants contained in the loan agreement , we may breach these covenants in the future . our ability to comply with these covenants may be affected by events and factors beyond our control . in the event that we breach one or more covenants , silicon valley bank may choose to declare an event of default and require that we immediately repay all amounts outstanding under the loan agreement , terminate any commitment to extend further credit and foreclose on the collateral . the occurrence of any of these events could have a material adverse effect on our business , financial condition and results

liquidity and capital resources since we commenced operations in late 2013 , we have devoted substantially all of our resources to research and development activities related to our r-snm system , including clinical and regulatory initiatives to obtain marketing approvals , and hiring and training our sales organization . additionally , to date , revenue generated from product sales has had minimal impact on our operations , and we have never been profitable . we have marketing approvals in europe , canada , and australia for all relevant clinical indications and initiated limited commercial efforts in europe and canada in late 2018. on september 6 , 2019 , our pma application for our r-snm system for the treatment of fi was approved by the fda and on november 13 , 2019 , our pma application for our r-snm system for the treatment of oab and ur was approved by the fda . our main commercial priority is the united states , where we began to commercialize and market our r-snm system and generate revenue from product sales in the fourth quarter of 2019. in addition to the united states , we expect to expend capital resources pursuing commercial operations in europe , canada , and australia , the amount and timing of which will depend on a variety of factors , including the size of the developed market for snm therapy , burdens to entry in any such country or region , and other factors specific to certain respective countries and regions .


 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 since we commenced operations in late 2013 , we have devoted substantially all of our resources to research and development activities related to our r-snm system , including clinical and regulatory initiatives to obtain marketing approvals , and hiring and training our sales organization . additionally , to date , revenue generated from product sales has had minimal impact on our operations , and we have never been profitable . we have marketing approvals in europe , canada , and australia for all relevant clinical indications and initiated limited commercial efforts in europe and canada in late 2018. on september 6 , 2019 , our pma application for our r-snm system for the treatment of fi was approved by the fda and on november 13 , 2019 , our pma application for our r-snm system for the treatment of oab and ur was approved by the fda . our main commercial priority is the united states , where we began to commercialize and market our r-snm system and generate revenue from product sales in the fourth quarter of 2019. in addition to the united states , we expect to expend capital resources pursuing commercial operations in europe , canada , and australia , the amount and timing of which will depend on a variety of factors , including the size of the developed market for snm therapy , burdens to entry in any such country or region , and other factors specific to certain respective countries and regions .
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 Suspicious Activity Report : most large insurers have established coverage policies in place to cover snm therapy . certain commercial payors have a patient-by-patient prior authorization process that must be followed before they will provide reimbursement for snm therapy . outside the united states , reimbursement levels vary significantly by country and by region , particularly based on whether the country or region at issue maintains a single-payor system . snm therapy is eligible for reimbursement in canada , australia , and certain countries in europe , such as germany , france , and the united kingdom . annual healthcare budgets generally determine the number of snm systems that will be paid for by the payor in these single-payor system countries and regions . we currently outsource the manufacture of the implantable components of our r-snm system . we plan to continue with an outsourced manufacturing arrangement for the foreseeable future . our contract manufacturers are all recognized in their field for their competency to manufacture the respective portions of our r-snm system and have quality systems established that meet fda requirements . we believe the manufacturers we currently utilize have sufficient capacity to meet our launch requirements and are able to scale up their capacity relatively quickly with limited capital investment . 76 prior to obtaining fda approval , we devoted substantially all of our resources to research and development activities related to our r-snm system , including clinical and regulatory initiatives to obtain marketing approvals . we expect to spend a significant amount of our resources on sales and marketing activities as we begin to commercialize and market our r-snm system in the united states . we incurred net losses of $ 79.9 million and $ 32.5 million for the years ended december 31 , 2019 and 2018 , and had an accumulated deficit of $ 179.6 million as of december 31 , 2019 compared to $ 99.6 million at december 31 , 2018 . as of december 31 , 2019 , we had available cash , cash equivalents and short-term investments of approximately $ 183.7 million , current liabilities of approximately $ 12.0 million , and long-term liabilities of approximately $ 24.8 million . prior to our ipo , we financed our operations primarily through preferred stock financings and amounts borrowed under the loan agreement . we have invested heavily in product development and continuous improvement to our r-snm system . we have also made significant investments in clinical studies to demonstrate the safety and effectiveness of our r-snm system and to support regulatory submissions . because of these and other factors , we expect to continue to incur net losses for the next few years and we may require additional funding , which may include future equity and debt financings . adequate funding may not be available to us on acceptable terms , or at all . our failure to obtain sufficient funds on acceptable terms when needed could have a material and adverse effect on our business , financial condition , and results of operations . initial public offering on november 2 , 2018 , we completed our ipo by issuing 9,200,000 shares of common stock , at an offering price of $ 15.00 per share , inclusive of 1,200,000 shares of our common stock issued upon the exercise by the underwriters of their option to purchase additional shares . the gross proceeds from the ipo were $ 138.0 million and the net proceeds were approximately $ 126.0 million , after deducting underwriting discounts , commissions and estimated offering expenses payable by us . in connection with the ipo , our outstanding shares of convertible preferred stock were automatically converted into an aggregate of 15,813,297 shares of common stock , and our outstanding warrants to purchase shares of series c convertible preferred stock were automatically converted into warrants to purchase up to an aggregate of 80,000 shares of common stock . follow-on offering on november 22 , 2019 , we completed a follow-on offering by issuing 5,345,000 shares of common stock , at an offering price of $ 22.00 per share , inclusive of 750,000 shares of our common stock issued upon the exercise by the underwriters of their option to purchase additional shares . the gross proceeds to us from this follow-on offering were $ 117.6 million and the net proceeds were approximately $ 110.4 million , after deducting underwriting discounts , commissions and estimated offering expenses payable by us . amf license agreement on october 1 , 2013 , we entered into the license agreement , pursuant to which amf granted us a royalty-bearing , sublicensable license to the amf ip . the license to the amf ip allows us to make , have made , lease , offer to lease , use , sell , offer for sale , market , promote , advertise , import , research , develop and commercialize the amf licensed products worldwide for the treatment of ( i ) chronic pain in humans through the application of electrical energy to the nervous system , ( ii ) inflammatory conditions of the human body through the application of electrical energy to the vagus nerve , a nerve that interfaces with parasympathic control of the heart , lungs and digestive tract and ( iii ) bladder and bowel dysfunction in humans through the application of electrical energy anywhere in or on the human body , excluding , in each case , any product or method that involves the placement of electrodes or the administration of electrical stimulation inside the cranial cavity or to the ocular nervous system or the auditory nervous system . we have the right to expand the field of use for the amf licensed products to the modulation of digestive process and treatment of digestive conditions in humans through the application of electrical energy anywhere in or on the body , subject to the exclusions described above . story_separator_special_tag net cash provided by ( used in ) investing activities net cash provided by investing activities was $ 45.3 million in fiscal year 2019 and consisted primarily of sales and maturities of short-term investments , partially offset by purchases of short-term investments . net cash used in investing activities was $ 60.1 million in fiscal year 2018 and consisted primarily of purchases and sales of short-term investments . 83 net cash provided by financing activities net cash provided by financing activities was $ 111.0 million in fiscal year 2019 and consisted primarily of $ 110.4 million in net proceeds received in the follow-on offering . net cash provided by financing activities was $ 165.3 million in fiscal year 2018 and consisted primarily of $ 126.0 million in net proceeds received in the ipo , $ 20.0 million of proceeds from our term loan with silicon valley bank , and $ 20.1 million of proceeds from the issuance of shares of our series c preferred stock . indebtedness in february 2018 , we entered into a loan and security agreement with silicon valley bank , which we and silicon valley bank amended in october 2018 and in december 2019 , providing for the term loan . pursuant to the loan agreement , we have drawn $ 20.0 million in three tranches of term loans , with such drawn obligations maturing on december 1 , 2021. the loan agreement provides for monthly interest payments but no principal amortization through december 31 , 2020. on the first day of the end of the interest only period , we will be required to repay the term loan in equal monthly installments of principal plus interest through maturity . outstanding principal balances under the term loan bear interest at the prime rate plus 1.75 % . we may prepay amounts outstanding under the term loan in increments of $ 5.0 million at any time with 30 days prior written notice to silicon valley bank . however , all prepayments of the term loan prior to maturity , whether voluntary or mandatory ( acceleration or otherwise ) , are also subject to the payment of a prepayment fee equal to ( i ) for a prepayment made on or after the closing date through and including the first anniversary of the closing date , 3.00 % of the principal amount of the term loan being prepaid , ( ii ) for a prepayment made after the date which is the first anniversary of the closing date through and including the second anniversary of the closing date , 2.00 % of the principal amount of the term loan being prepaid , and ( iii ) for a prepayment made after the date which is the second anniversary of the closing date and before the maturity date , 1.00 % of the principal amount of the term loan being prepaid . additionally , on the earliest to occur of ( i ) the maturity date of the term loan , ( ii ) the acceleration of the term loan , or ( iii ) the prepayment of the term loan , we will be required to make a final payment equal to the original principal amount of such tranche multiplied by 7.50 % . we are currently accruing the portion of the final payment calculated based on the amount outstanding under the term loan . all obligations under the term loan are secured by a first priority lien on substantially all of our assets , excluding intellectual property assets and more than 65 % of the shares of voting capital stock of any of our foreign subsidiaries . we have agreed with silicon valley bank not to encumber our intellectual property assets without its prior written consent unless a security interest in the underlying intellectual property is necessary to have a security interest in the accounts and proceeds that are part of the assets securing the term loan , in which case our intellectual property shall automatically be included within the assets securing the term loan . the loan agreement contains certain covenants that limit our ability to engage in certain transactions that may be in our long-term best interest . subject to certain limited exceptions , these covenants limit our ability to or prohibit us to permit any of our subsidiaries to , as applicable , among other things : pay cash dividends on , make any other distributions in respect of , or redeem , retire or repurchase , any shares of our capital stock ; convey , sell , lease , transfer , assign , or otherwise dispose of all or any part of our business or property ; effect certain changes in our business , management , ownership or business locations ; merge or consolidate with , or acquire all or substantially all of the capital stock or property of any other company ; create , incur , assume , or be liable for any additional indebtedness , or create , incur , allow , or permit to exist any additional liens ; make certain investments ; and enter into transactions with our affiliates . 84 as of december 31 , 2019 , we were in compliance with all debt covenant requirements under the term loan . while we have not previously breached and are currently in compliance with the covenants contained in the loan agreement , we may breach these covenants in the future . our ability to comply with these covenants may be affected by events and factors beyond our control . in the event that we breach one or more covenants , silicon valley bank may choose to declare an event of default and require that we immediately repay all amounts outstanding under the loan agreement , terminate any commitment to extend further credit and foreclose on the collateral . the occurrence of any of these events could have a material adverse effect on our business , financial condition and results

