in september 2020 , health canada approved a second-generation rechargeable ins for our r-snm system , which the company began shipping upon approval . in february 2021 , the fda approved a third-generation ins for our r-snm system under a pma supplement . the third-generation ins upgrades the embedded software in the ins and the functionality of the patient remote control . these modifications give patients the ability to make broader stimulation parameter 78 adjustments at home , including selecting a second therapy program that was set post-operatively based on interoperative findings . our ability to generate revenue and become profitable will depend on our ability to continue to successfully commercialize our r-snm system and any product enhancements we may advance in the future . we expect to derive future revenue by increasing patient and physician awareness of our r-snm system . if we are unable to accomplish any of these objectives , it could have a significant negative impact on our future revenue . if we fail to generate sufficient revenue in the future , our business , results of operations , financial condition , cash flows , and future prospects would be materially and adversely affected . we also intend to continue to make investments in research and development efforts to develop improvements and enhancements to our r-snm system . in the united states , the cost required to treat each patient is reimbursed through various third-party payors , such as commercial payors and government agencies . 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 . 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 commercialize and market our r-snm system in the united states . we incurred net losses of $ 54.9 million , $ 79.9 million , and $ 32.5 million for the years ended december 31 , 2020 , 2019 , and 2018 , respectively , and had an accumulated deficit of $ 234.5 million as of december 31 , 2020 compared to $ 179.6 million at december 31 , 2019. as of december 31 , 2020 , we had available cash and cash equivalents of approximately $ 241.2 million , current liabilities of approximately $ 45.7 million , and long-term liabilities of approximately $ 9.2 million . prior to our initial public offering ( ipo ) , we financed our operations primarily through preferred stock financings and amounts borrowed under a loan and security agreement , dated february 6 , 2018 , between us and silicon valley bank ( the loan agreement ) . through our ipo in november 2018 , an offering completed in november 2019 and an offering completed in may 2020 , we received aggregate gross proceeds of approximately $ 405.1 million . 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 . 79 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 . story_separator_special_tag the loan and security agreement contains customary events of default that include , among others , non-payment defaults , covenant defaults , a default in the event a material adverse change occurs , defaults in the event our assets are attached or we are enjoined from doing business , bankruptcy and insolvency defaults , cross-defaults to certain other material indebtedness , material judgment defaults , and inaccuracy of representations and warranties . the occurrence of an event of default could result in an increase to the applicable interest rate of 5.00 % , acceleration of and present occurrence of the maturity date , and the consequent obligation for us to repay in full in cash all amounts outstanding under the loan and security agreement , and a right by the lenders to exercise all remedies available under the loan and security agreement and related agreements , including the right to dispose of the collateral as permitted under applicable law . we may need to raise additional financing in the future to facilitate our business operations . if we raise additional funds by issuing equity securities , our stockholders could experience dilution . debt financing , if available , may involve covenants further restricting our operations or our ability to incur additional debt . any debt financing or additional equity that we raise may contain terms that are not favorable to us or our stockholders . additional financing may not be available at all , or in amounts or on terms acceptable to us . if we are unable to obtain additional financing when needed to satisfy our liquidity requirements , we may be required to scale back our operations . story_separator_special_tag href= `` https : //www.sec.gov/archives/edgar/data/0001603756/000160375621000014/ # id71b78c8dd4641e0a2e1393b007d5311_7 `` style= `` color : # 0000ff ; font-family : 'times new roman ' , sans-serif ; font-size:10pt ; font-weight:400 ; line-height:120 % ; text-decoration : underline `` > ( 2 ) purchase obligations represent open purchase orders primarily for component materials and third-party contract labor costs at the end of the fiscal year . these purchase orders can be impacted by various factors , including the timing of issuing orders , the timing of the shipment of orders , and currency fluctuations . ( 3 ) represents the minimum royalty due under the license agreement . ( 4 ) includes interest payments at the prime rate plus 1.75 % , prepayment fees , and the minimum final payment , consisting of a 7.5 % premium principal amount paid off under the loan agreement , all of which were repaid in full in january 2021. fees or payments under the loan and security agreement are not included . from time to time we enter into certain types of contracts that contingently require us to indemnify parties against third-party claims , including the license agreement , the loan agreement , the loan and security agreement and certain real estate leases , supply purchase agreements , and agreements with directors and officers . the terms of such obligations vary by contract and in most instances a maximum dollar amount is not explicitly stated therein . generally , amounts under these contracts can not be reasonably estimated until a specific claim is asserted , thus no liabilities have been recorded for these obligations on our balance sheets for any of the periods presented . critical accounting policies and estimates the preparation of consolidated financial statements in conformity with accounting principles generally accepted in the united states ( gaap ) requires our management to make estimates and judgments that affect the amounts reported in our consolidated financial statements and accompanying notes . we base our estimates on historical experience and on various other assumptions that we believe to be reasonable under the circumstances . the results of this evaluation then form the basis for making judgments about the carrying values of assets and liabilities that are not readily apparent from other sources . actual results may differ from these estimates under different assumptions or conditions , and such differences may be material to our consolidated financial statements . while our significant accounting policies are more fully described in note 1 to the consolidated financial statements in part ii , item 8 of this annual report on form 10-k , we believe the following discussion addresses our most critical accounting policies , which are those that are most important to the portrayal of our financial condition and results of operations and require our most difficult , subjective and complex judgments . revenue recognition revenue recognized during the years ended december 31 , 2020 , 2019 , and 2018 relates entirely to the sale of our r-snm system . we have revenue arrangements that consist of a single performance obligation . we recognize revenue at the point in time when it transfers control of promised goods to its customers . revenue is measured as the amount of consideration it expects to receive in exchange for transferring goods . the amount of revenue that is recognized is based on the transaction price , which represents the invoiced amount and includes estimates of variable consideration such as discounts , where applicable . we do not offer rights of return or price protection . the amount of variable consideration included in the transaction price may be constrained and is included only to the extent that it is probable that a significant reversal in the amount of the cumulative revenue recognized under the contract will not occur in a future period . payment terms , typically less than three months , are offered to our customers and do not include a significant financing component . we extend credit to our customers based upon an evaluation of the customer 's financial condition and credit history and generally require no collateral . we do not have any contract balances related to product sales . we also do not have significant contract acquisition costs related to product sales . shipping and handling costs incurred for

cash flows the following table presents a summary of our cash flow for the periods indicated ( in thousands ) : replace_table_token_4_th net cash used in operating activities net cash used in operating activities was $ 83.7 million in fiscal year 2020 and consisted primarily of a net loss of $ 54.9 million , a decrease from changes in net operating assets of $ 47.0 million , partially offset by non-cash charges of $ 18.2 million . net operating assets consisted primarily of inventory to support the commercial launch of our r-snm system in the united states . non-cash charges consisted primarily of stock-based compensation . net cash used in operating activities was $ 83.5 million in fiscal year 2019 and consisted primarily of a net loss of $ 79.9 million , a decrease in net operating assets of $ 14.4 million , partially offset by non-cash charges of $ 10.9 million . net operating assets consisted primarily of inventory to support the commercial launch of our r-snm system in the united states . non-cash charges consisted primarily of stock-based compensation . net cash used in operating activities was $ 31.4 million in fiscal year 2018 and consisted primarily of a net loss of $ 32.5 million , a decrease in net operating assets of $ 2.9 million , partially offset by non-cash charges of $ 4.0 million . net operating assets consisted primarily of inventory to support the planned launch of our commercial 86 operations .


 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 presents a summary of our cash flow for the periods indicated ( in thousands ) : replace_table_token_4_th net cash used in operating activities net cash used in operating activities was $ 83.7 million in fiscal year 2020 and consisted primarily of a net loss of $ 54.9 million , a decrease from changes in net operating assets of $ 47.0 million , partially offset by non-cash charges of $ 18.2 million . net operating assets consisted primarily of inventory to support the commercial launch of our r-snm system in the united states . non-cash charges consisted primarily of stock-based compensation . net cash used in operating activities was $ 83.5 million in fiscal year 2019 and consisted primarily of a net loss of $ 79.9 million , a decrease in net operating assets of $ 14.4 million , partially offset by non-cash charges of $ 10.9 million . net operating assets consisted primarily of inventory to support the commercial launch of our r-snm system in the united states . non-cash charges consisted primarily of stock-based compensation . net cash used in operating activities was $ 31.4 million in fiscal year 2018 and consisted primarily of a net loss of $ 32.5 million , a decrease in net operating assets of $ 2.9 million , partially offset by non-cash charges of $ 4.0 million . net operating assets consisted primarily of inventory to support the planned launch of our commercial 86 operations .
```    
 Suspicious Activity Report : in september 2020 , health canada approved a second-generation rechargeable ins for our r-snm system , which the company began shipping upon approval . in february 2021 , the fda approved a third-generation ins for our r-snm system under a pma supplement . the third-generation ins upgrades the embedded software in the ins and the functionality of the patient remote control . these modifications give patients the ability to make broader stimulation parameter 78 adjustments at home , including selecting a second therapy program that was set post-operatively based on interoperative findings . our ability to generate revenue and become profitable will depend on our ability to continue to successfully commercialize our r-snm system and any product enhancements we may advance in the future . we expect to derive future revenue by increasing patient and physician awareness of our r-snm system . if we are unable to accomplish any of these objectives , it could have a significant negative impact on our future revenue . if we fail to generate sufficient revenue in the future , our business , results of operations , financial condition , cash flows , and future prospects would be materially and adversely affected . we also intend to continue to make investments in research and development efforts to develop improvements and enhancements to our r-snm system . in the united states , the cost required to treat each patient is reimbursed through various third-party payors , such as commercial payors and government agencies . 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 . 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 commercialize and market our r-snm system in the united states . we incurred net losses of $ 54.9 million , $ 79.9 million , and $ 32.5 million for the years ended december 31 , 2020 , 2019 , and 2018 , respectively , and had an accumulated deficit of $ 234.5 million as of december 31 , 2020 compared to $ 179.6 million at december 31 , 2019. as of december 31 , 2020 , we had available cash and cash equivalents of approximately $ 241.2 million , current liabilities of approximately $ 45.7 million , and long-term liabilities of approximately $ 9.2 million . prior to our initial public offering ( ipo ) , we financed our operations primarily through preferred stock financings and amounts borrowed under a loan and security agreement , dated february 6 , 2018 , between us and silicon valley bank ( the loan agreement ) . through our ipo in november 2018 , an offering completed in november 2019 and an offering completed in may 2020 , we received aggregate gross proceeds of approximately $ 405.1 million . 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 . 79 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 . story_separator_special_tag the loan and security agreement contains customary events of default that include , among others , non-payment defaults , covenant defaults , a default in the event a material adverse change occurs , defaults in the event our assets are attached or we are enjoined from doing business , bankruptcy and insolvency defaults , cross-defaults to certain other material indebtedness , material judgment defaults , and inaccuracy of representations and warranties . the occurrence of an event of default could result in an increase to the applicable interest rate of 5.00 % , acceleration of and present occurrence of the maturity date , and the consequent obligation for us to repay in full in cash all amounts outstanding under the loan and security agreement , and a right by the lenders to exercise all remedies available under the loan and security agreement and related agreements , including the right to dispose of the collateral as permitted under applicable law . we may need to raise additional financing in the future to facilitate our business operations . if we raise additional funds by issuing equity securities , our stockholders could experience dilution . debt financing , if available , may involve covenants further restricting our operations or our ability to incur additional debt . any debt financing or additional equity that we raise may contain terms that are not favorable to us or our stockholders . additional financing may not be available at all , or in amounts or on terms acceptable to us . if we are unable to obtain additional financing when needed to satisfy our liquidity requirements , we may be required to scale back our operations . story_separator_special_tag href= `` https : //www.sec.gov/archives/edgar/data/0001603756/000160375621000014/ # id71b78c8dd4641e0a2e1393b007d5311_7 `` style= `` color : # 0000ff ; font-family : 'times new roman ' , sans-serif ; font-size:10pt ; font-weight:400 ; line-height:120 % ; text-decoration : underline `` > ( 2 ) purchase obligations represent open purchase orders primarily for component materials and third-party contract labor costs at the end of the fiscal year . these purchase orders can be impacted by various factors , including the timing of issuing orders , the timing of the shipment of orders , and currency fluctuations . ( 3 ) represents the minimum royalty due under the license agreement . ( 4 ) includes interest payments at the prime rate plus 1.75 % , prepayment fees , and the minimum final payment , consisting of a 7.5 % premium principal amount paid off under the loan agreement , all of which were repaid in full in january 2021. fees or payments under the loan and security agreement are not included . from time to time we enter into certain types of contracts that contingently require us to indemnify parties against third-party claims , including the license agreement , the loan agreement , the loan and security agreement and certain real estate leases , supply purchase agreements , and agreements with directors and officers . the terms of such obligations vary by contract and in most instances a maximum dollar amount is not explicitly stated therein . generally , amounts under these contracts can not be reasonably estimated until a specific claim is asserted , thus no liabilities have been recorded for these obligations on our balance sheets for any of the periods presented . critical accounting policies and estimates the preparation of consolidated financial statements in conformity with accounting principles generally accepted in the united states ( gaap ) requires our management to make estimates and judgments that affect the amounts reported in our consolidated financial statements and accompanying notes . we base our estimates on historical experience and on various other assumptions that we believe to be reasonable under the circumstances . the results of this evaluation then form the basis for making judgments about the carrying values of assets and liabilities that are not readily apparent from other sources . actual results may differ from these estimates under different assumptions or conditions , and such differences may be material to our consolidated financial statements . while our significant accounting policies are more fully described in note 1 to the consolidated financial statements in part ii , item 8 of this annual report on form 10-k , we believe the following discussion addresses our most critical accounting policies , which are those that are most important to the portrayal of our financial condition and results of operations and require our most difficult , subjective and complex judgments . revenue recognition revenue recognized during the years ended december 31 , 2020 , 2019 , and 2018 relates entirely to the sale of our r-snm system . we have revenue arrangements that consist of a single performance obligation . we recognize revenue at the point in time when it transfers control of promised goods to its customers . revenue is measured as the amount of consideration it expects to receive in exchange for transferring goods . the amount of revenue that is recognized is based on the transaction price , which represents the invoiced amount and includes estimates of variable consideration such as discounts , where applicable . we do not offer rights of return or price protection . the amount of variable consideration included in the transaction price may be constrained and is included only to the extent that it is probable that a significant reversal in the amount of the cumulative revenue recognized under the contract will not occur in a future period . payment terms , typically less than three months , are offered to our customers and do not include a significant financing component . we extend credit to our customers based upon an evaluation of the customer 's financial condition and credit history and generally require no collateral . we do not have any contract balances related to product sales . we also do not have significant contract acquisition costs related to product sales . shipping and handling costs incurred for

