competition for new engagements and pricing pressure has been strong . throughout 2017 , many of our healthcare clients did not begin new projects when existing projects ended due to their capital constraints . the demand for the company 's information and technology-related solutions business , primarily in our healthcare vertical market in north america improved in 2018 and 2019 as spending increased along with the improving economy . the company operates in one industry segment , providing information and technology-related services to its clients . these services include information and technology-related solutions , including supplemental staffing as a solution . with solutions services , we generally take responsibility for the deliverables and some level of project and staff management , and services may include high-end advisory or business related consulting . when providing staffing services , including managed staffing , staff augmentation , and volume staffing , we typically supply personnel to our clients who then , in turn , take their direction from the clients ' managers . it solutions and it and other staffing revenue as a percentage of consolidated revenue for the three years ended december 31 , 2019 , 2018 , and 2017 is as follows : replace_table_token_8_th the company promotes a majority of its services through five vertical market focus areas : technology service providers , manufacturing , healthcare ( which includes services provided to healthcare providers , health insurers ( payers ) , and life sciences companies ) , financial services , and energy . the remainder of ctg 's revenue is derived from general markets . 19 ctg 's revenue by vertical market as a percentage of consolidated revenue for the three years ended december 31 , 2019 , 2018 , and 2017 is as follows : replace_table_token_9_th the it services industry is extremely competitive and characterized by continuous changes in client requirements and improvements in technologies . our competition varies significantly by geographic region , as well as by the type of service provided . many of our competitors are larger than ctg , and have greater financial , technical , sales , and marketing resources . in addition , the company frequently competes with a client 's own internal it staff . our industry is impacted by the growing use of lower-cost offshore delivery capabilities ( primarily india and other parts of asia ) . there can be no assurance that we will be able to continue to compete successfully with existing or future competitors or that future competition will not have a material adverse effect on our results of operations and financial condition . revenue recognition the company recognizes revenue when control of the promised good or service is transferred to clients , in an amount that reflects the consideration the company expects to be entitled to in exchange for those goods or services . for time-and-material contracts , revenue is recognized as hours are incurred and costs are expended . for contracts with progress billing schedules , primarily monthly , revenue is recognized as services are rendered to the client . revenue for fixed-price contracts is recognized over time using an input-based approach . over time revenue recognition best portrays the company 's performance in transferring control of the goods or services to the client . on most fixed price contracts , revenue recognition is supported through contractual clauses that require the client to pay for work performed to date , including cost plus a reasonable profit margin , for goods or services that have no alternative use to the company . on certain contracts , revenue recognition is supported through contractual clauses that indicate the client controls the asset , or work in process , as the company creates or enhances the asset . on a given project , actual salary and indirect labor costs incurred are measured and compared with the total estimate of costs of such items at the completion of the project . revenue is recognized based upon the percentage-of-completion calculation of total incurred costs to total estimated costs . the company infrequently works on fixed-price projects that include significant amounts of material or other non-labor related costs that could distort the percent complete within a percentage-of-completion calculation . the company 's estimate of the total labor costs it expects to incur over the term of the contract is based on the nature of the project and our experience on similar projects , and includes management judgments and estimates that affect the amount of revenue recognized on fixed-price contracts in any accounting period . losses on fixed-price projects are recorded when identified . the company 's revenue from contracts accounted for under time-and-material , progress billing , and percentage-of-completion methods as a percentage of consolidated revenue for the three years ended december 31 , 2019 , 2018 , and 2017 is as follows : replace_table_token_10_th 20 results of operations the table below sets forth percentage information calculated as a percentage of consolidated revenue as reported on the company 's consolidated statements of operations as included in item 8 , “ financial statements and supplementary data ” in this report . replace_table_token_11_th 2019 as compared with 2018 the company recorded revenue in 2019 and 2018 as follows : replace_table_token_12_th the company 's focus , throughout its operations , is to expand the amount of it solutions services it provides to its clients , as compared with it staffing services , and to become a solutions-centric company . it solutions provide significant value to our clients , and drive higher bill rates and margins for the company . our existing solutions , such as application maintenance and outsourcing , data management and testing , combined with new or expanded solutions through acquisitions , will give the company a broader set of it solutions to provide to its clients . additionally , the company will continue to expand the capabilities of its existing solutions by adding elements such as robotic process automation and artificial intelligence . story_separator_special_tag in the 2017 third quarter , the company recorded a significant increase in fringe benefit costs primarily consisting of medical expense . the increase in medical expense , which totaled approximately $ 1.0 million in direct costs , was due to much higher utilization of the company 's self-insured medical plan during the year . the company also recorded $ 0.4 million of severance charges in the 2017 second quarter . when considering these items , direct costs as a percentage of revenue in 2018 were comparable in 2017. selling , general and administrative ( sg & a ) expenses were 18.5 % of revenue in 2018 as compared with 17.2 % of revenue in 2017. the increase in sg & a expenses as a percentage of revenue in 2018 as compared with 2017 was primarily due to costs incurred by our operating units as the company continued to make investments in sales , recruiting and delivery resources in order to focus on the company 's long-term growth . additionally , sg & a in 2018 includes acquisition-related costs , including the amortization of intangible assets associated with the acquisition of soft company , totaling $ 2.0 million , and $ 0.7 million in severance . operating income was 0.6 % of revenue in 2018 as compared with 1.4 % of revenue in 2017. the operating loss from the north american operations was $ 2.4 million in 2018 compared with $ 0.1 million in 2017. the 2018 loss was impacted by investments in business development , recruiting , and marketing of nearly $ 3.5 million , some of which have yet to generate revenue and profits . additionally , the company recorded $ 2.0 million in acquisition related costs , and $ 0.7 million in severance . operating income in 2017 was reduced by a total of $ 2.0 million from unusually high utilization of the company 's self-insured medical plan , and severance . 24 operating income from our european operations was $ 5.3 million in 2018 compared with $ 4.0 million in 2017 . the increase in operating income in 2018 compared with 2017 wa s primarily due to strong demand for the company 's services in the european markets we serve , and the acquisition of soft company completed in february 2018. other income ( expense ) was 0.1 % of revenue in 2018 and 0.0 % of revenue in 2017. in 2018 and 2017 , the company recorded a non-taxable life insurance gain of approximately $ 0.8 and $ 0.4 million , respectively , as one of its former executives passed away in each year . the company 's effective tax rate ( etr ) is calculated based upon the full year 's operating results and various tax related items . the etr in 2018 was 224.2 % , while the 2017 etr was 80.1 % . the etr was high in 2018 primarily due to the company recording a valuation allowance for its deferred tax assets in the u.s. totaling $ 3.8 million as the company has recurring pre-tax losses in recent years and uncertainty as to income in future years . the company also incurred approximately $ 0.7 million of tax associated with the gilti provisions of the 2017 tax cut and jobs act , and $ 0.3 million of tax from non-deductible acquisition-related costs in our foreign operations . these items , which caused additional tax expense , were offset by a non-taxable life insurance gain , the reversal of the valuation for deferred tax assets in the united kingdom , the tax cut and jobs act which reduced the u.s. federal corporate tax rate to 21 % , and tax benefits for the work opportunity tax credit ( wotc ) and research and development tax credit ( r & d ) . the etr was high in 2017 primarily due to the effects of the tax cuts & jobs act which resulted in the company reducing its u.s. deferred tax assets by $ 1.7 million , and the adoption of asu 2016-09 , “ improvements to employee share-based payment accounting , ” which required the company to record additional tax expense of $ 0.3 million for shortfalls that would previously have been recorded to capital in excess of par value on the company 's consolidated balance sheet . this additional tax expense was partially offset by tax benefits for the work opportunity tax credit ( wotc ) and research and development tax credit ( r & d ) . net loss for 2018 was ( 0.8 ) % of revenue or $ ( 0.20 ) per diluted share , compared with net income of 0.3 % of revenue or $ 0.05 per diluted share in 2017. diluted earnings per share were calculated using 13.8 million weighted-average equivalent shares outstanding in 2018 and 15.3 million in 2017. the decrease in shares year-over-year was due to the company 's dutch auction tender offer where the company repurchased approximately 10 % of its outstanding shares in april 2018. critical accounting policies the preparation of financial statements and related disclosures in conformity with u.s. generally accepted accounting principles requires the company 's management to make estimates , judgments and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes . the company 's significant accounting policies are included in note 1 to the consolidated financial statements contained in this annual report on form 10-k under item 8 , “ financial statements and supplementary data . ” these policies , along with the underlying assumptions and judgments made by the company 's management in their application , have a significant impact on the company 's consolidated financial statements . the company identifies its most critical accounting policies as those that are the most pervasive and important to the portrayal of the company 's financial position and results of operations , and that require the most difficult , subjective and or complex judgments by

financial condition and liquidity cash provided by ( used in ) operating activities was $ 8.5 million , $ ( 0.3 ) million , and $ 9.2 million in 2019 , 2018 , and 2017 , respectively . in 2019 , net income was $ 4.1 million , while other non-cash adjustments , primarily consisting of depreciation and amortization expense , equity-based compensation , deferred income taxes , and deferred compensation totaled $ 4.3 million . in 2018 and 2017 , net income ( loss ) was $ ( 2.8 ) million and $ 0.8 million , respectively , while the corresponding non-cash adjustments netted to $ 6.3 million and $ 4.5 million , respectively . accounts receivable balances increased $ 3.6 million in 2019 as compared with 2018 , increased $ 8.7 million in 2018 as compared with 2017 , and decreased $ 5.2 million in 2017 as compared with 2016. the increase in the accounts receivable balance in 2019 resulted from an increase in revenue of 6.6 % in the 2019 fourth quarter as compared with the 2018 fourth quarter . in addition , the company 's days sales outstanding ( dso ) increased in 2019 as compared with 2018. dso is calculated by dividing accounts receivable obtained from the consolidated balance sheet by average daily revenue for the fourth quarter of the respective year . dso was 85 days at december 31 , 2019 as compared with dso at december 31 , 2018 of 82 days . dso was 82 days at december 31 , 2018 as compared with dso at december 31 , 2017 of 86 days .


 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.
     ```financial condition and liquidity cash provided by ( used in ) operating activities was $ 8.5 million , $ ( 0.3 ) million , and $ 9.2 million in 2019 , 2018 , and 2017 , respectively . in 2019 , net income was $ 4.1 million , while other non-cash adjustments , primarily consisting of depreciation and amortization expense , equity-based compensation , deferred income taxes , and deferred compensation totaled $ 4.3 million . in 2018 and 2017 , net income ( loss ) was $ ( 2.8 ) million and $ 0.8 million , respectively , while the corresponding non-cash adjustments netted to $ 6.3 million and $ 4.5 million , respectively . accounts receivable balances increased $ 3.6 million in 2019 as compared with 2018 , increased $ 8.7 million in 2018 as compared with 2017 , and decreased $ 5.2 million in 2017 as compared with 2016. the increase in the accounts receivable balance in 2019 resulted from an increase in revenue of 6.6 % in the 2019 fourth quarter as compared with the 2018 fourth quarter . in addition , the company 's days sales outstanding ( dso ) increased in 2019 as compared with 2018. dso is calculated by dividing accounts receivable obtained from the consolidated balance sheet by average daily revenue for the fourth quarter of the respective year . dso was 85 days at december 31 , 2019 as compared with dso at december 31 , 2018 of 82 days . dso was 82 days at december 31 , 2018 as compared with dso at december 31 , 2017 of 86 days .
```    
 Suspicious Activity Report : competition for new engagements and pricing pressure has been strong . throughout 2017 , many of our healthcare clients did not begin new projects when existing projects ended due to their capital constraints . the demand for the company 's information and technology-related solutions business , primarily in our healthcare vertical market in north america improved in 2018 and 2019 as spending increased along with the improving economy . the company operates in one industry segment , providing information and technology-related services to its clients . these services include information and technology-related solutions , including supplemental staffing as a solution . with solutions services , we generally take responsibility for the deliverables and some level of project and staff management , and services may include high-end advisory or business related consulting . when providing staffing services , including managed staffing , staff augmentation , and volume staffing , we typically supply personnel to our clients who then , in turn , take their direction from the clients ' managers . it solutions and it and other staffing revenue as a percentage of consolidated revenue for the three years ended december 31 , 2019 , 2018 , and 2017 is as follows : replace_table_token_8_th the company promotes a majority of its services through five vertical market focus areas : technology service providers , manufacturing , healthcare ( which includes services provided to healthcare providers , health insurers ( payers ) , and life sciences companies ) , financial services , and energy . the remainder of ctg 's revenue is derived from general markets . 19 ctg 's revenue by vertical market as a percentage of consolidated revenue for the three years ended december 31 , 2019 , 2018 , and 2017 is as follows : replace_table_token_9_th the it services industry is extremely competitive and characterized by continuous changes in client requirements and improvements in technologies . our competition varies significantly by geographic region , as well as by the type of service provided . many of our competitors are larger than ctg , and have greater financial , technical , sales , and marketing resources . in addition , the company frequently competes with a client 's own internal it staff . our industry is impacted by the growing use of lower-cost offshore delivery capabilities ( primarily india and other parts of asia ) . there can be no assurance that we will be able to continue to compete successfully with existing or future competitors or that future competition will not have a material adverse effect on our results of operations and financial condition . revenue recognition the company recognizes revenue when control of the promised good or service is transferred to clients , in an amount that reflects the consideration the company expects to be entitled to in exchange for those goods or services . for time-and-material contracts , revenue is recognized as hours are incurred and costs are expended . for contracts with progress billing schedules , primarily monthly , revenue is recognized as services are rendered to the client . revenue for fixed-price contracts is recognized over time using an input-based approach . over time revenue recognition best portrays the company 's performance in transferring control of the goods or services to the client . on most fixed price contracts , revenue recognition is supported through contractual clauses that require the client to pay for work performed to date , including cost plus a reasonable profit margin , for goods or services that have no alternative use to the company . on certain contracts , revenue recognition is supported through contractual clauses that indicate the client controls the asset , or work in process , as the company creates or enhances the asset . on a given project , actual salary and indirect labor costs incurred are measured and compared with the total estimate of costs of such items at the completion of the project . revenue is recognized based upon the percentage-of-completion calculation of total incurred costs to total estimated costs . the company infrequently works on fixed-price projects that include significant amounts of material or other non-labor related costs that could distort the percent complete within a percentage-of-completion calculation . the company 's estimate of the total labor costs it expects to incur over the term of the contract is based on the nature of the project and our experience on similar projects , and includes management judgments and estimates that affect the amount of revenue recognized on fixed-price contracts in any accounting period . losses on fixed-price projects are recorded when identified . the company 's revenue from contracts accounted for under time-and-material , progress billing , and percentage-of-completion methods as a percentage of consolidated revenue for the three years ended december 31 , 2019 , 2018 , and 2017 is as follows : replace_table_token_10_th 20 results of operations the table below sets forth percentage information calculated as a percentage of consolidated revenue as reported on the company 's consolidated statements of operations as included in item 8 , “ financial statements and supplementary data ” in this report . replace_table_token_11_th 2019 as compared with 2018 the company recorded revenue in 2019 and 2018 as follows : replace_table_token_12_th the company 's focus , throughout its operations , is to expand the amount of it solutions services it provides to its clients , as compared with it staffing services , and to become a solutions-centric company . it solutions provide significant value to our clients , and drive higher bill rates and margins for the company . our existing solutions , such as application maintenance and outsourcing , data management and testing , combined with new or expanded solutions through acquisitions , will give the company a broader set of it solutions to provide to its clients . additionally , the company will continue to expand the capabilities of its existing solutions by adding elements such as robotic process automation and artificial intelligence . story_separator_special_tag in the 2017 third quarter , the company recorded a significant increase in fringe benefit costs primarily consisting of medical expense . the increase in medical expense , which totaled approximately $ 1.0 million in direct costs , was due to much higher utilization of the company 's self-insured medical plan during the year . the company also recorded $ 0.4 million of severance charges in the 2017 second quarter . when considering these items , direct costs as a percentage of revenue in 2018 were comparable in 2017. selling , general and administrative ( sg & a ) expenses were 18.5 % of revenue in 2018 as compared with 17.2 % of revenue in 2017. the increase in sg & a expenses as a percentage of revenue in 2018 as compared with 2017 was primarily due to costs incurred by our operating units as the company continued to make investments in sales , recruiting and delivery resources in order to focus on the company 's long-term growth . additionally , sg & a in 2018 includes acquisition-related costs , including the amortization of intangible assets associated with the acquisition of soft company , totaling $ 2.0 million , and $ 0.7 million in severance . operating income was 0.6 % of revenue in 2018 as compared with 1.4 % of revenue in 2017. the operating loss from the north american operations was $ 2.4 million in 2018 compared with $ 0.1 million in 2017. the 2018 loss was impacted by investments in business development , recruiting , and marketing of nearly $ 3.5 million , some of which have yet to generate revenue and profits . additionally , the company recorded $ 2.0 million in acquisition related costs , and $ 0.7 million in severance . operating income in 2017 was reduced by a total of $ 2.0 million from unusually high utilization of the company 's self-insured medical plan , and severance . 24 operating income from our european operations was $ 5.3 million in 2018 compared with $ 4.0 million in 2017 . the increase in operating income in 2018 compared with 2017 wa s primarily due to strong demand for the company 's services in the european markets we serve , and the acquisition of soft company completed in february 2018. other income ( expense ) was 0.1 % of revenue in 2018 and 0.0 % of revenue in 2017. in 2018 and 2017 , the company recorded a non-taxable life insurance gain of approximately $ 0.8 and $ 0.4 million , respectively , as one of its former executives passed away in each year . the company 's effective tax rate ( etr ) is calculated based upon the full year 's operating results and various tax related items . the etr in 2018 was 224.2 % , while the 2017 etr was 80.1 % . the etr was high in 2018 primarily due to the company recording a valuation allowance for its deferred tax assets in the u.s. totaling $ 3.8 million as the company has recurring pre-tax losses in recent years and uncertainty as to income in future years . the company also incurred approximately $ 0.7 million of tax associated with the gilti provisions of the 2017 tax cut and jobs act , and $ 0.3 million of tax from non-deductible acquisition-related costs in our foreign operations . these items , which caused additional tax expense , were offset by a non-taxable life insurance gain , the reversal of the valuation for deferred tax assets in the united kingdom , the tax cut and jobs act which reduced the u.s. federal corporate tax rate to 21 % , and tax benefits for the work opportunity tax credit ( wotc ) and research and development tax credit ( r & d ) . the etr was high in 2017 primarily due to the effects of the tax cuts & jobs act which resulted in the company reducing its u.s. deferred tax assets by $ 1.7 million , and the adoption of asu 2016-09 , “ improvements to employee share-based payment accounting , ” which required the company to record additional tax expense of $ 0.3 million for shortfalls that would previously have been recorded to capital in excess of par value on the company 's consolidated balance sheet . this additional tax expense was partially offset by tax benefits for the work opportunity tax credit ( wotc ) and research and development tax credit ( r & d ) . net loss for 2018 was ( 0.8 ) % of revenue or $ ( 0.20 ) per diluted share , compared with net income of 0.3 % of revenue or $ 0.05 per diluted share in 2017. diluted earnings per share were calculated using 13.8 million weighted-average equivalent shares outstanding in 2018 and 15.3 million in 2017. the decrease in shares year-over-year was due to the company 's dutch auction tender offer where the company repurchased approximately 10 % of its outstanding shares in april 2018. critical accounting policies the preparation of financial statements and related disclosures in conformity with u.s. generally accepted accounting principles requires the company 's management to make estimates , judgments and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes . the company 's significant accounting policies are included in note 1 to the consolidated financial statements contained in this annual report on form 10-k under item 8 , “ financial statements and supplementary data . ” these policies , along with the underlying assumptions and judgments made by the company 's management in their application , have a significant impact on the company 's consolidated financial statements . the company identifies its most critical accounting policies as those that are the most pervasive and important to the portrayal of the company 's financial position and results of operations , and that require the most difficult , subjective and or complex judgments by

