patients access our tests through their physician . our afirma , percepta and envisia tests are used as part of the diagnostic process and genomic testing services are performed in our clia laboratory located in san francisco , california . cytopathology services for afirma testing are performed in our reference laboratory in austin , texas . the prosigna test is indicated in female breast cancer patients who have undergone surgery in conjunction with locoregional treatment consistent with standard of care . this in vitro diagnostic test is performed on the ncounter flex analysis system in laboratories worldwide , as well as in the united states . fourth quarter and full-year 2019 financial results 56 for the three months ended december 31 , 2019 , compared to the prior year : total revenue was $ 29.7 million , an increase of 15 % ; gross margin was 66 % , unchanged ; operating expenses , excluding cost of revenue , were $ 27.8 million , an increase of 38 % ; net loss and comprehensive loss was ( $ 7.5 ) million , an increase of 140 % ; basic and diluted net loss per common share was ( $ 0.15 ) , an increase of 88 % ; net cash provided by operating activities was $ 1.8 million , compared to $ 1.2 million used ; and cash and cash equivalents was $ 159.3 million at december 31 , 2019. for the year ended december 31 , 2019 , compared to the prior year : total revenue was $ 120.4 million , an increase of 31 % ; gross margin was 70 % , an increase of six percentage points ; operating expenses , excluding cost of revenue , were $ 99.0 million , an increase of 22 % ; net loss and comprehensive loss was ( $ 12.6 ) million , an improvement of 45 % ; basic and diluted net loss per common share was ( $ 0.27 ) , an improvement of 56 % ; and net cash used in operating activities was $ 3.2 million , an improvement of 76 % . 2019 full-year and recent business highlights commercial growth : achieved strong total revenue growth across our testing and product portfolio delivering $ 29.5 million in the fourth quarter and $ 108.3 million for 2019 , an increase of 16 % and 19 % , respectively , compared to the prior year . accelerated pulmonology testing revenue to $ 2.0 million and $ 5.5 million for the fourth quarter and full year , respectively , a 123 % and 174 % increase compared to prior year . grew total genomic volume ( afirma , percepta and envisia ) by 18 % to 10,846 tests in the fourth quarter of 2019 and by 25 % to 39,612 tests in 2019 , compared to prior year . increased genomic volume for our pulmonology products by 136 % in 2019 compared to prior year , achieving growth targets for both the percepta and envisia classifiers . received final medicare coverage in march 2019 for the envisia classifier and published strong clinical validation and clinical utility data in the lancet respiratory medicine , propelling nationwide commercial expansion of the test in the second half of 2019. expanded payer contracts by 14.4 million lives , making veracyte an in-network genomic testing provider to health plans representing over 225 million members . continued to build an extensive library of clinical data across our portfolio in 2019 , including 8 publications and 11 presentations at leading medical meetings , demonstrating our afirma and pulmonology tests ' performance and clinical utility . eleven abstracts were presented at the san antonio breast cancer symposium in december 2019 , including data showing a benefit of prosigna ® over other genomic testing to identify patients ' long-term risk of developing distant metastases . in addition , data were presented showing the test 's ability to identify patients with intrinsic breast cancer subtypes that may potentially benefit from cdk4/6 inhibitors in place of standard chemotherapy . biopharmaceutical collaborations/pipeline advancement : in january 2019 , announced a long-term strategic collaboration with johnson & johnson innovation llc to advance the development and commercialization of novel diagnostic tests to detect lung cancer at its earliest stages , when the disease is most treatable . presented preliminary data at the american college of chest physicians ( chest ) annual meeting for our first-of-its-kind noninvasive nasal swab classifier for improved lung cancer diagnosis . the test , being developed through our johnson & johnson collaboration , is expected to launch in early 2021. launched the second-generation percepta gsc , completing the transition of our core classifiers to our rna whole-transcriptome sequencing platform . 57 announced a multi-year collaboration with acerta pharma , the hematology research and development arm of astrazeneca plc , to provide genomic information that will support the biopharmaceutical company 's development of oncology therapeutics in lymphoma . global expansion : acquired the exclusive global diagnostic rights to the nanostring ncounter flex analysis system , as well as the prosigna breast cancer assay and the in-development lymphmark lymphoma subtyping test . we believe this transaction positions us to access a $ 40 billion global market for our current and pipeline products , by offering a broad menu of advanced genomic tests in oncology and other indications using a distributed-kit model . factors affecting our performance reported genomic test volume our performance depends on the number of genomic tests that we perform and report as completed in our clia laboratories . story_separator_special_tag timing of our research and development expenses we deploy state-of-the-art and costly genomic technologies in our biomarker discovery experiments , and our spending on these technologies may vary substantially from quarter to quarter . we also spend a significant amount to secure clinical samples that can be used in discovery and product development as well as clinical validation studies . the timing of these research and development activities is difficult to predict , as is the timing of sample acquisitions . if a substantial number of clinical samples are acquired in a given quarter or if a high-cost experiment is conducted in one quarter versus the next , the timing of these expenses can affect our financial results . we conduct clinical studies to validate our new products as well as on-going clinical studies to further the published evidence to support our commercialized tests . as these studies are initiated , start-up costs for each site can be significant and concentrated in a specific quarter . spending on research and development , for both experiments and studies , may vary significantly by quarter depending on the timing of these various expenses . 61 financial overview testing revenue through december 31 , 2019 , we derived a substantial majority of our revenue from the sale of afirma delivered primarily to physicians in the united states . we generally invoice third-party payers upon delivery of a patient report to the prescribing physician . as such , we take the assignment of benefits and the risk of cash collection from the third-party payer and individual patients . third-party payers and other customers in excess of 10 % of total revenue and their related revenue as a percentage of total revenue were as follows : replace_table_token_4_th for tests performed , we recognize the related revenue upon delivery of a patient report to the prescribing physician based on the amount that we expect to ultimately receive . in determining the amount to accrue for a delivered test , we consider factors such as payment history , payer coverage , whether there is a reimbursement contract between the payer and us , payment as a percentage of agreed upon reimbursement rate ( if applicable ) , amount paid per test and any current development or changes that could impact reimbursement . upon ultimate collection , the amount received is compared to previous estimates and the amount accrued is adjusted accordingly . our ability to increase our revenue will depend on our ability to penetrate the market , obtain positive coverage policies from additional third-party payers , obtain reimbursement and or enter into contracts with additional third-party payers for our current and new tests , and increase reimbursement rates for tests performed . finally , should the judgments underlying our estimated reimbursement change , our accrued revenue and financial results could be negatively impacted in future periods . cost of testing revenue the components of our cost of revenue are laboratory expenses , kit costs , sample collection expenses , compensation expense , license fees and royalties , depreciation and amortization , other expenses such as equipment and laboratory supplies , and allocations of facility and information technology expenses . costs associated with performing tests are recorded as the test is processed regardless of whether and when revenue is recognized with respect to that test . as a result , our cost of revenue as a percentage of revenue may vary significantly from period to period because we may not recognize all revenue in the period in which the associated costs are incurred . we expect cost of revenue in absolute dollars to increase as the number of tests we perform increases . however , we expect that the cost per test will decrease over time due to leveraging fixed costs , efficiencies we may gain as test volume increases and from automation , process efficiencies and other cost reductions . as we introduce new tests , initially our cost of revenue will be high as we expect to run suboptimal batch sizes , run quality control batches , test batches , registry samples and generally incur costs that may suppress or reduce gross margins . this will disproportionately increase our aggregate cost of revenue until we achieve efficiencies in processing these new tests . cost of product revenue cost of product revenue consists primarily of costs of purchasing instruments and consumables from third-party contract manufacturers , installation , warranty , service and packaging and delivery costs . in addition , cost of product includes royalty costs for licensed technologies included in our products , provisions for slow-moving and obsolete inventory and stock-based compensation expense . cost of product revenue for instruments and consumables is recognized in the period the related revenue is recognized . shipping and handling costs incurred for product shipments are included in cost of product in the consolidated statements of operations . research and development research and development expenses include expenses incurred to develop our technology , collect clinical samples and conduct clinical studies to develop and support our products and pipeline . these expenses consist of compensation expenses , direct research and development expenses such as prototype materials , laboratory supplies and costs associated with setting up and 62 conducting clinical studies at domestic and international sites , professional fees , depreciation and amortization , other miscellaneous expenses and allocation of facility and information technology expenses . we expense all research and development costs in the periods in which they are incurred . we expect to incur significant research and development expenses as we continue to invest in research and development activities related to developing additional products and evaluating various platforms . we incurred research and development expenses on ongoing evidence development for our afirma , percepta and envisia classifiers in 2019 . we believe a majority of our research and development expenses in and after 2020 will be predominantly in support of our pipeline products . selling and marketing selling and

cash flows the following table summarizes our cash flows for the years ended december 31 , 2019 , 2018 and 2017 ( in thousands of dollars ) : replace_table_token_10_th cash flows from operating activities cash used in operating activities for the year ended december 31 , 2019 was $ 3.2 million . the net loss of $ 12.6 million includes non-cash charges of $ 9.8 million of stock-based compensation expense and $ 4.1 million of depreciation and amortization , which includes $ 1.4 million of intangible asset amortization , and $ 0.2 million of end-of-term debt obligation accruals . cash used as a result of changes in operating assets and liabilities was $ 4.8 million , primarily comprised of an increase in accounts receivable of $ 6.2 million , increase in supplies of $ 3.4 million and increase in other assets of $ 0.4 million , partially offset by an increase in accrued liabilities and deferred rent of $ 5.2 million . cash used in operating activities for the year ended december 31 , 2018 was $ 13.5 million . the net loss of $ 23.0 million includes non-cash charges of $ 6.0 million of stock-based compensation expense and $ 3.9 million of depreciation and amortization , which includes $ 1.1 million of intangible asset amortization . it also includes $ 0.3 million of end-of-term debt obligation accruals . cash used as a result of changes in operating assets and liabilities of $ 0.7 million was primarily due to a decrease in accounts payable of $ 1.6 million , an increase in other assets of $ 0.8 million and increases in prepaid expenses and other current assets and accounts receivable of $ 0.9 million , partially offset by a decrease in supplies of $ 1.9


 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 summarizes our cash flows for the years ended december 31 , 2019 , 2018 and 2017 ( in thousands of dollars ) : replace_table_token_10_th cash flows from operating activities cash used in operating activities for the year ended december 31 , 2019 was $ 3.2 million . the net loss of $ 12.6 million includes non-cash charges of $ 9.8 million of stock-based compensation expense and $ 4.1 million of depreciation and amortization , which includes $ 1.4 million of intangible asset amortization , and $ 0.2 million of end-of-term debt obligation accruals . cash used as a result of changes in operating assets and liabilities was $ 4.8 million , primarily comprised of an increase in accounts receivable of $ 6.2 million , increase in supplies of $ 3.4 million and increase in other assets of $ 0.4 million , partially offset by an increase in accrued liabilities and deferred rent of $ 5.2 million . cash used in operating activities for the year ended december 31 , 2018 was $ 13.5 million . the net loss of $ 23.0 million includes non-cash charges of $ 6.0 million of stock-based compensation expense and $ 3.9 million of depreciation and amortization , which includes $ 1.1 million of intangible asset amortization . it also includes $ 0.3 million of end-of-term debt obligation accruals . cash used as a result of changes in operating assets and liabilities of $ 0.7 million was primarily due to a decrease in accounts payable of $ 1.6 million , an increase in other assets of $ 0.8 million and increases in prepaid expenses and other current assets and accounts receivable of $ 0.9 million , partially offset by a decrease in supplies of $ 1.9
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 Suspicious Activity Report : patients access our tests through their physician . our afirma , percepta and envisia tests are used as part of the diagnostic process and genomic testing services are performed in our clia laboratory located in san francisco , california . cytopathology services for afirma testing are performed in our reference laboratory in austin , texas . the prosigna test is indicated in female breast cancer patients who have undergone surgery in conjunction with locoregional treatment consistent with standard of care . this in vitro diagnostic test is performed on the ncounter flex analysis system in laboratories worldwide , as well as in the united states . fourth quarter and full-year 2019 financial results 56 for the three months ended december 31 , 2019 , compared to the prior year : total revenue was $ 29.7 million , an increase of 15 % ; gross margin was 66 % , unchanged ; operating expenses , excluding cost of revenue , were $ 27.8 million , an increase of 38 % ; net loss and comprehensive loss was ( $ 7.5 ) million , an increase of 140 % ; basic and diluted net loss per common share was ( $ 0.15 ) , an increase of 88 % ; net cash provided by operating activities was $ 1.8 million , compared to $ 1.2 million used ; and cash and cash equivalents was $ 159.3 million at december 31 , 2019. for the year ended december 31 , 2019 , compared to the prior year : total revenue was $ 120.4 million , an increase of 31 % ; gross margin was 70 % , an increase of six percentage points ; operating expenses , excluding cost of revenue , were $ 99.0 million , an increase of 22 % ; net loss and comprehensive loss was ( $ 12.6 ) million , an improvement of 45 % ; basic and diluted net loss per common share was ( $ 0.27 ) , an improvement of 56 % ; and net cash used in operating activities was $ 3.2 million , an improvement of 76 % . 2019 full-year and recent business highlights commercial growth : achieved strong total revenue growth across our testing and product portfolio delivering $ 29.5 million in the fourth quarter and $ 108.3 million for 2019 , an increase of 16 % and 19 % , respectively , compared to the prior year . accelerated pulmonology testing revenue to $ 2.0 million and $ 5.5 million for the fourth quarter and full year , respectively , a 123 % and 174 % increase compared to prior year . grew total genomic volume ( afirma , percepta and envisia ) by 18 % to 10,846 tests in the fourth quarter of 2019 and by 25 % to 39,612 tests in 2019 , compared to prior year . increased genomic volume for our pulmonology products by 136 % in 2019 compared to prior year , achieving growth targets for both the percepta and envisia classifiers . received final medicare coverage in march 2019 for the envisia classifier and published strong clinical validation and clinical utility data in the lancet respiratory medicine , propelling nationwide commercial expansion of the test in the second half of 2019. expanded payer contracts by 14.4 million lives , making veracyte an in-network genomic testing provider to health plans representing over 225 million members . continued to build an extensive library of clinical data across our portfolio in 2019 , including 8 publications and 11 presentations at leading medical meetings , demonstrating our afirma and pulmonology tests ' performance and clinical utility . eleven abstracts were presented at the san antonio breast cancer symposium in december 2019 , including data showing a benefit of prosigna ® over other genomic testing to identify patients ' long-term risk of developing distant metastases . in addition , data were presented showing the test 's ability to identify patients with intrinsic breast cancer subtypes that may potentially benefit from cdk4/6 inhibitors in place of standard chemotherapy . biopharmaceutical collaborations/pipeline advancement : in january 2019 , announced a long-term strategic collaboration with johnson & johnson innovation llc to advance the development and commercialization of novel diagnostic tests to detect lung cancer at its earliest stages , when the disease is most treatable . presented preliminary data at the american college of chest physicians ( chest ) annual meeting for our first-of-its-kind noninvasive nasal swab classifier for improved lung cancer diagnosis . the test , being developed through our johnson & johnson collaboration , is expected to launch in early 2021. launched the second-generation percepta gsc , completing the transition of our core classifiers to our rna whole-transcriptome sequencing platform . 57 announced a multi-year collaboration with acerta pharma , the hematology research and development arm of astrazeneca plc , to provide genomic information that will support the biopharmaceutical company 's development of oncology therapeutics in lymphoma . global expansion : acquired the exclusive global diagnostic rights to the nanostring ncounter flex analysis system , as well as the prosigna breast cancer assay and the in-development lymphmark lymphoma subtyping test . we believe this transaction positions us to access a $ 40 billion global market for our current and pipeline products , by offering a broad menu of advanced genomic tests in oncology and other indications using a distributed-kit model . factors affecting our performance reported genomic test volume our performance depends on the number of genomic tests that we perform and report as completed in our clia laboratories . story_separator_special_tag timing of our research and development expenses we deploy state-of-the-art and costly genomic technologies in our biomarker discovery experiments , and our spending on these technologies may vary substantially from quarter to quarter . we also spend a significant amount to secure clinical samples that can be used in discovery and product development as well as clinical validation studies . the timing of these research and development activities is difficult to predict , as is the timing of sample acquisitions . if a substantial number of clinical samples are acquired in a given quarter or if a high-cost experiment is conducted in one quarter versus the next , the timing of these expenses can affect our financial results . we conduct clinical studies to validate our new products as well as on-going clinical studies to further the published evidence to support our commercialized tests . as these studies are initiated , start-up costs for each site can be significant and concentrated in a specific quarter . spending on research and development , for both experiments and studies , may vary significantly by quarter depending on the timing of these various expenses . 61 financial overview testing revenue through december 31 , 2019 , we derived a substantial majority of our revenue from the sale of afirma delivered primarily to physicians in the united states . we generally invoice third-party payers upon delivery of a patient report to the prescribing physician . as such , we take the assignment of benefits and the risk of cash collection from the third-party payer and individual patients . third-party payers and other customers in excess of 10 % of total revenue and their related revenue as a percentage of total revenue were as follows : replace_table_token_4_th for tests performed , we recognize the related revenue upon delivery of a patient report to the prescribing physician based on the amount that we expect to ultimately receive . in determining the amount to accrue for a delivered test , we consider factors such as payment history , payer coverage , whether there is a reimbursement contract between the payer and us , payment as a percentage of agreed upon reimbursement rate ( if applicable ) , amount paid per test and any current development or changes that could impact reimbursement . upon ultimate collection , the amount received is compared to previous estimates and the amount accrued is adjusted accordingly . our ability to increase our revenue will depend on our ability to penetrate the market , obtain positive coverage policies from additional third-party payers , obtain reimbursement and or enter into contracts with additional third-party payers for our current and new tests , and increase reimbursement rates for tests performed . finally , should the judgments underlying our estimated reimbursement change , our accrued revenue and financial results could be negatively impacted in future periods . cost of testing revenue the components of our cost of revenue are laboratory expenses , kit costs , sample collection expenses , compensation expense , license fees and royalties , depreciation and amortization , other expenses such as equipment and laboratory supplies , and allocations of facility and information technology expenses . costs associated with performing tests are recorded as the test is processed regardless of whether and when revenue is recognized with respect to that test . as a result , our cost of revenue as a percentage of revenue may vary significantly from period to period because we may not recognize all revenue in the period in which the associated costs are incurred . we expect cost of revenue in absolute dollars to increase as the number of tests we perform increases . however , we expect that the cost per test will decrease over time due to leveraging fixed costs , efficiencies we may gain as test volume increases and from automation , process efficiencies and other cost reductions . as we introduce new tests , initially our cost of revenue will be high as we expect to run suboptimal batch sizes , run quality control batches , test batches , registry samples and generally incur costs that may suppress or reduce gross margins . this will disproportionately increase our aggregate cost of revenue until we achieve efficiencies in processing these new tests . cost of product revenue cost of product revenue consists primarily of costs of purchasing instruments and consumables from third-party contract manufacturers , installation , warranty , service and packaging and delivery costs . in addition , cost of product includes royalty costs for licensed technologies included in our products , provisions for slow-moving and obsolete inventory and stock-based compensation expense . cost of product revenue for instruments and consumables is recognized in the period the related revenue is recognized . shipping and handling costs incurred for product shipments are included in cost of product in the consolidated statements of operations . research and development research and development expenses include expenses incurred to develop our technology , collect clinical samples and conduct clinical studies to develop and support our products and pipeline . these expenses consist of compensation expenses , direct research and development expenses such as prototype materials , laboratory supplies and costs associated with setting up and 62 conducting clinical studies at domestic and international sites , professional fees , depreciation and amortization , other miscellaneous expenses and allocation of facility and information technology expenses . we expense all research and development costs in the periods in which they are incurred . we expect to incur significant research and development expenses as we continue to invest in research and development activities related to developing additional products and evaluating various platforms . we incurred research and development expenses on ongoing evidence development for our afirma , percepta and envisia classifiers in 2019 . we believe a majority of our research and development expenses in and after 2020 will be predominantly in support of our pipeline products . selling and marketing selling and

