one such product is the patient safe ® syringe , which is uniquely designed to reduce the risk of bloodstream infections associated with catheter hub contamination . in the second quarter of 2016 , we began selling the easypoint ® needle . easypoint ® needles made up 7.2 % of revenues in 2019. the easypoint ® is a retractable needle that can be used with luer lock syringes , luer slip syringes , and prefilled syringes to give injections . the easypoint ® needle can also be used to aspirate fluids and collect blood . historically , unit sales have increased in the latter part of the year due , in part , to the demand for syringes during the flu season . our products have been and continue to be distributed nationally and internationally through numerous distributors . although we have made limited progress in some areas , such as the alternate care market , our volumes are not as high as they should be given the nature and quality of our products and the federal and state legislation requiring the use of safe needle devices . the alternate care market is composed of facilities that provide long-term nursing and out-patient surgery , emergency care , physician services , health clinics , and retail pharmacies . we continue to pursue various strategies to have better access to the hospital market , as well as other markets , including attempting to gain access to the market through our sales efforts , our innovative technology , introduction of new products , and , when necessary , litigation . the further consolidated appropriations act , 2020 , signed into law on december 20 , 2019 , has permanently repealed the 2.3 % medical device excise tax . prior to the repeal , the tax was on a 4-year moratorium . as a result of the repeal and the prior moratorium , sales of taxable medical devices after december 31 , 2015 , are not subject to the tax . product purchases from our chinese manufacturers have enabled us to increase manufacturing capacity with little capital outlay and have provided a competitive manufacturing cost . in 2019 , our chinese manufacturers produced approximately 82.6 % of our products . as of march 23 , 2020 , we believe we have sufficient inventory to fulfill demand despite having experienced a temporary disruption in our supply of products from china due to the recent coronavirus ( covid-19 ) precautions in that country . our suppliers in china have resumed production and shipments of products from china have been received . in the event that we become unable to purchase products from our chinese manufacturers , we would need to find an alternate manufacturer for the blood collection set , iv 11 catheter , patient safe ® syringe , 0.5ml insulin syringe , 0.5ml autodisable syringe , and 2ml , 5ml , and 10ml syringes and we would increase domestic production for the 1ml and 3ml syringes . in 1995 , we entered into a license agreement with thomas j. shaw for the exclusive right to manufacture , market , and distribute products utilizing his patented automated retraction technology and other patented technology . this technology is the subject of various patents and patent applications owned by mr. shaw . the license agreement generally provides for quarterly payments of a 5 % royalty fee on gross sales of products subject to the license and he receives fifty percent ( 50 % ) of the royalties paid to the company by certain sublicensees of the technology subject to the license . with increased volumes , our manufacturing unit costs have generally tended to decline . factors that could affect our unit costs include increases in costs by third party manufacturers , changing production volumes , costs of petroleum products , and transportation costs . increases in such costs may not be recoverable through price increases of our products . results of operations the following discussion contains trend information and other forward-looking statements that involve a number of risks and uncertainties . our actual future results could differ materially from our historical results of operations and those discussed in the forward-looking statements . all period references are to our fiscal years ended december 2019 and 2018. dollar amounts have been rounded for ease of reading . comparison of year ended december 31 , 2019 and year ended december 31 , 2018 domestic sales accounted for 76.6 % and 86.1 % of the revenues in 2019 and 2018 , respectively . domestic revenues increased 11.3 % principally due to increased volumes , including sales of vanishpoint ® products . domestic unit sales increased 4.9 % . domestic unit sales were 67.9 % of total unit sales for 2019. international revenues , excluding product licensing fees , increased from $ 4.6 million in 2018 to $ 9.7 million in 2019 , primarily due to higher unit sales . overall unit sales increased 25 % . our international orders may be subject to significant fluctuation over time . such orders may fluctuate due to health initiatives at various times as well as economic conditions . cost of manufactured product increased $ 4.1 million principally due to an increase in units sold . royalty expense increased $ 506 thousand due to increased gross sales . gross profit margins increased from 30.7 % in 2018 to 33.8 % in 2019 principally due to an overall increase in sales . operating expenses decreased 5.5 % from the prior year due to cost cutting measures in the fourth quarter of 2018. these decreases were partially offset by increases in other operating costs . the loss from operations was $ 1.3 million in 2018 compared to income from operations of $ 3.0 million in 2019. cash flow from operations was $ 2.2 million in 2019 due to our net income for the year . the increase in cash was offset by an increase in accounts receivable story_separator_special_tag one such product is the patient safe ® syringe , which is uniquely designed to reduce the risk of bloodstream infections associated with catheter hub contamination . in the second quarter of 2016 , we began selling the easypoint ® needle . easypoint ® needles made up 7.2 % of revenues in 2019. the easypoint ® is a retractable needle that can be used with luer lock syringes , luer slip syringes , and prefilled syringes to give injections . the easypoint ® needle can also be used to aspirate fluids and collect blood . historically , unit sales have increased in the latter part of the year due , in part , to the demand for syringes during the flu season . our products have been and continue to be distributed nationally and internationally through numerous distributors . although we have made limited progress in some areas , such as the alternate care market , our volumes are not as high as they should be given the nature and quality of our products and the federal and state legislation requiring the use of safe needle devices . the alternate care market is composed of facilities that provide long-term nursing and out-patient surgery , emergency care , physician services , health clinics , and retail pharmacies . we continue to pursue various strategies to have better access to the hospital market , as well as other markets , including attempting to gain access to the market through our sales efforts , our innovative technology , introduction of new products , and , when necessary , litigation . the further consolidated appropriations act , 2020 , signed into law on december 20 , 2019 , has permanently repealed the 2.3 % medical device excise tax . prior to the repeal , the tax was on a 4-year moratorium . as a result of the repeal and the prior moratorium , sales of taxable medical devices after december 31 , 2015 , are not subject to the tax . product purchases from our chinese manufacturers have enabled us to increase manufacturing capacity with little capital outlay and have provided a competitive manufacturing cost . in 2019 , our chinese manufacturers produced approximately 82.6 % of our products . as of march 23 , 2020 , we believe we have sufficient inventory to fulfill demand despite having experienced a temporary disruption in our supply of products from china due to the recent coronavirus ( covid-19 ) precautions in that country . our suppliers in china have resumed production and shipments of products from china have been received . in the event that we become unable to purchase products from our chinese manufacturers , we would need to find an alternate manufacturer for the blood collection set , iv 11 catheter , patient safe ® syringe , 0.5ml insulin syringe , 0.5ml autodisable syringe , and 2ml , 5ml , and 10ml syringes and we would increase domestic production for the 1ml and 3ml syringes . in 1995 , we entered into a license agreement with thomas j. shaw for the exclusive right to manufacture , market , and distribute products utilizing his patented automated retraction technology and other patented technology . this technology is the subject of various patents and patent applications owned by mr. shaw . the license agreement generally provides for quarterly payments of a 5 % royalty fee on gross sales of products subject to the license and he receives fifty percent ( 50 % ) of the royalties paid to the company by certain sublicensees of the technology subject to the license . with increased volumes , our manufacturing unit costs have generally tended to decline . factors that could affect our unit costs include increases in costs by third party manufacturers , changing production volumes , costs of petroleum products , and transportation costs . increases in such costs may not be recoverable through price increases of our products . results of operations the following discussion contains trend information and other forward-looking statements that involve a number of risks and uncertainties . our actual future results could differ materially from our historical results of operations and those discussed in the forward-looking statements . all period references are to our fiscal years ended december 2019 and 2018. dollar amounts have been rounded for ease of reading . comparison of year ended december 31 , 2019 and year ended december 31 , 2018 domestic sales accounted for 76.6 % and 86.1 % of the revenues in 2019 and 2018 , respectively . domestic revenues increased 11.3 % principally due to increased volumes , including sales of vanishpoint ® products . domestic unit sales increased 4.9 % . domestic unit sales were 67.9 % of total unit sales for 2019. international revenues , excluding product licensing fees , increased from $ 4.6 million in 2018 to $ 9.7 million in 2019 , primarily due to higher unit sales . overall unit sales increased 25 % . our international orders may be subject to significant fluctuation over time . such orders may fluctuate due to health initiatives at various times as well as economic conditions . cost of manufactured product increased $ 4.1 million principally due to an increase in units sold . royalty expense increased $ 506 thousand due to increased gross sales . gross profit margins increased from 30.7 % in 2018 to 33.8 % in 2019 principally due to an overall increase in sales . operating expenses decreased 5.5 % from the prior year due to cost cutting measures in the fourth quarter of 2018. these decreases were partially offset by increases in other operating costs . the loss from operations was $ 1.3 million in 2018 compared to income from operations of $ 3.0 million in 2019. cash flow from operations was $ 2.2 million in 2019 due to our net income for the year . the increase in cash was offset by an increase in accounts receivable

liquidity and capital resources 12 at the present time , management does not intend to publicly raise equity capital . due to the funds received from prior litigation and direct purchase of stock , we have sufficient cash reserves and intend to rely on operations , cash reserves , and debt financing , when available , as the primary ongoing sources of cash . our ability to obtain additional funds through loans is uncertain . in 2019 , we transferred $ 4.5 million from our cash accounts into investments in certificates of deposit , exchange-traded and closed-end funds ( etfs ) , and mutual funds . this transfer principally caused our net decrease in cash in 2019. the securities may increase investment income in the future . however , the investment of 22 % of our liquid assets in an investment account presents substantial risk as well . in 2019 , a portfolio rebalancing caused a significant nonrecurring cash event whereby we recognized $ 2.7 million from sales of investments . historical sources of liquidity we have historically funded operations primarily from the proceeds from revenues , private placements , litigation settlements , and loans . internal sources of liquidity margins and market access to routinely achieve positive or break-even quarters , we need increased access to hospital markets which has been difficult to obtain .


 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 12 at the present time , management does not intend to publicly raise equity capital . due to the funds received from prior litigation and direct purchase of stock , we have sufficient cash reserves and intend to rely on operations , cash reserves , and debt financing , when available , as the primary ongoing sources of cash . our ability to obtain additional funds through loans is uncertain . in 2019 , we transferred $ 4.5 million from our cash accounts into investments in certificates of deposit , exchange-traded and closed-end funds ( etfs ) , and mutual funds . this transfer principally caused our net decrease in cash in 2019. the securities may increase investment income in the future . however , the investment of 22 % of our liquid assets in an investment account presents substantial risk as well . in 2019 , a portfolio rebalancing caused a significant nonrecurring cash event whereby we recognized $ 2.7 million from sales of investments . historical sources of liquidity we have historically funded operations primarily from the proceeds from revenues , private placements , litigation settlements , and loans . internal sources of liquidity margins and market access to routinely achieve positive or break-even quarters , we need increased access to hospital markets which has been difficult to obtain .
```    
 Suspicious Activity Report : one such product is the patient safe ® syringe , which is uniquely designed to reduce the risk of bloodstream infections associated with catheter hub contamination . in the second quarter of 2016 , we began selling the easypoint ® needle . easypoint ® needles made up 7.2 % of revenues in 2019. the easypoint ® is a retractable needle that can be used with luer lock syringes , luer slip syringes , and prefilled syringes to give injections . the easypoint ® needle can also be used to aspirate fluids and collect blood . historically , unit sales have increased in the latter part of the year due , in part , to the demand for syringes during the flu season . our products have been and continue to be distributed nationally and internationally through numerous distributors . although we have made limited progress in some areas , such as the alternate care market , our volumes are not as high as they should be given the nature and quality of our products and the federal and state legislation requiring the use of safe needle devices . the alternate care market is composed of facilities that provide long-term nursing and out-patient surgery , emergency care , physician services , health clinics , and retail pharmacies . we continue to pursue various strategies to have better access to the hospital market , as well as other markets , including attempting to gain access to the market through our sales efforts , our innovative technology , introduction of new products , and , when necessary , litigation . the further consolidated appropriations act , 2020 , signed into law on december 20 , 2019 , has permanently repealed the 2.3 % medical device excise tax . prior to the repeal , the tax was on a 4-year moratorium . as a result of the repeal and the prior moratorium , sales of taxable medical devices after december 31 , 2015 , are not subject to the tax . product purchases from our chinese manufacturers have enabled us to increase manufacturing capacity with little capital outlay and have provided a competitive manufacturing cost . in 2019 , our chinese manufacturers produced approximately 82.6 % of our products . as of march 23 , 2020 , we believe we have sufficient inventory to fulfill demand despite having experienced a temporary disruption in our supply of products from china due to the recent coronavirus ( covid-19 ) precautions in that country . our suppliers in china have resumed production and shipments of products from china have been received . in the event that we become unable to purchase products from our chinese manufacturers , we would need to find an alternate manufacturer for the blood collection set , iv 11 catheter , patient safe ® syringe , 0.5ml insulin syringe , 0.5ml autodisable syringe , and 2ml , 5ml , and 10ml syringes and we would increase domestic production for the 1ml and 3ml syringes . in 1995 , we entered into a license agreement with thomas j. shaw for the exclusive right to manufacture , market , and distribute products utilizing his patented automated retraction technology and other patented technology . this technology is the subject of various patents and patent applications owned by mr. shaw . the license agreement generally provides for quarterly payments of a 5 % royalty fee on gross sales of products subject to the license and he receives fifty percent ( 50 % ) of the royalties paid to the company by certain sublicensees of the technology subject to the license . with increased volumes , our manufacturing unit costs have generally tended to decline . factors that could affect our unit costs include increases in costs by third party manufacturers , changing production volumes , costs of petroleum products , and transportation costs . increases in such costs may not be recoverable through price increases of our products . results of operations the following discussion contains trend information and other forward-looking statements that involve a number of risks and uncertainties . our actual future results could differ materially from our historical results of operations and those discussed in the forward-looking statements . all period references are to our fiscal years ended december 2019 and 2018. dollar amounts have been rounded for ease of reading . comparison of year ended december 31 , 2019 and year ended december 31 , 2018 domestic sales accounted for 76.6 % and 86.1 % of the revenues in 2019 and 2018 , respectively . domestic revenues increased 11.3 % principally due to increased volumes , including sales of vanishpoint ® products . domestic unit sales increased 4.9 % . domestic unit sales were 67.9 % of total unit sales for 2019. international revenues , excluding product licensing fees , increased from $ 4.6 million in 2018 to $ 9.7 million in 2019 , primarily due to higher unit sales . overall unit sales increased 25 % . our international orders may be subject to significant fluctuation over time . such orders may fluctuate due to health initiatives at various times as well as economic conditions . cost of manufactured product increased $ 4.1 million principally due to an increase in units sold . royalty expense increased $ 506 thousand due to increased gross sales . gross profit margins increased from 30.7 % in 2018 to 33.8 % in 2019 principally due to an overall increase in sales . operating expenses decreased 5.5 % from the prior year due to cost cutting measures in the fourth quarter of 2018. these decreases were partially offset by increases in other operating costs . the loss from operations was $ 1.3 million in 2018 compared to income from operations of $ 3.0 million in 2019. cash flow from operations was $ 2.2 million in 2019 due to our net income for the year . the increase in cash was offset by an increase in accounts receivable story_separator_special_tag one such product is the patient safe ® syringe , which is uniquely designed to reduce the risk of bloodstream infections associated with catheter hub contamination . in the second quarter of 2016 , we began selling the easypoint ® needle . easypoint ® needles made up 7.2 % of revenues in 2019. the easypoint ® is a retractable needle that can be used with luer lock syringes , luer slip syringes , and prefilled syringes to give injections . the easypoint ® needle can also be used to aspirate fluids and collect blood . historically , unit sales have increased in the latter part of the year due , in part , to the demand for syringes during the flu season . our products have been and continue to be distributed nationally and internationally through numerous distributors . although we have made limited progress in some areas , such as the alternate care market , our volumes are not as high as they should be given the nature and quality of our products and the federal and state legislation requiring the use of safe needle devices . the alternate care market is composed of facilities that provide long-term nursing and out-patient surgery , emergency care , physician services , health clinics , and retail pharmacies . we continue to pursue various strategies to have better access to the hospital market , as well as other markets , including attempting to gain access to the market through our sales efforts , our innovative technology , introduction of new products , and , when necessary , litigation . the further consolidated appropriations act , 2020 , signed into law on december 20 , 2019 , has permanently repealed the 2.3 % medical device excise tax . prior to the repeal , the tax was on a 4-year moratorium . as a result of the repeal and the prior moratorium , sales of taxable medical devices after december 31 , 2015 , are not subject to the tax . product purchases from our chinese manufacturers have enabled us to increase manufacturing capacity with little capital outlay and have provided a competitive manufacturing cost . in 2019 , our chinese manufacturers produced approximately 82.6 % of our products . as of march 23 , 2020 , we believe we have sufficient inventory to fulfill demand despite having experienced a temporary disruption in our supply of products from china due to the recent coronavirus ( covid-19 ) precautions in that country . our suppliers in china have resumed production and shipments of products from china have been received . in the event that we become unable to purchase products from our chinese manufacturers , we would need to find an alternate manufacturer for the blood collection set , iv 11 catheter , patient safe ® syringe , 0.5ml insulin syringe , 0.5ml autodisable syringe , and 2ml , 5ml , and 10ml syringes and we would increase domestic production for the 1ml and 3ml syringes . in 1995 , we entered into a license agreement with thomas j. shaw for the exclusive right to manufacture , market , and distribute products utilizing his patented automated retraction technology and other patented technology . this technology is the subject of various patents and patent applications owned by mr. shaw . the license agreement generally provides for quarterly payments of a 5 % royalty fee on gross sales of products subject to the license and he receives fifty percent ( 50 % ) of the royalties paid to the company by certain sublicensees of the technology subject to the license . with increased volumes , our manufacturing unit costs have generally tended to decline . factors that could affect our unit costs include increases in costs by third party manufacturers , changing production volumes , costs of petroleum products , and transportation costs . increases in such costs may not be recoverable through price increases of our products . results of operations the following discussion contains trend information and other forward-looking statements that involve a number of risks and uncertainties . our actual future results could differ materially from our historical results of operations and those discussed in the forward-looking statements . all period references are to our fiscal years ended december 2019 and 2018. dollar amounts have been rounded for ease of reading . comparison of year ended december 31 , 2019 and year ended december 31 , 2018 domestic sales accounted for 76.6 % and 86.1 % of the revenues in 2019 and 2018 , respectively . domestic revenues increased 11.3 % principally due to increased volumes , including sales of vanishpoint ® products . domestic unit sales increased 4.9 % . domestic unit sales were 67.9 % of total unit sales for 2019. international revenues , excluding product licensing fees , increased from $ 4.6 million in 2018 to $ 9.7 million in 2019 , primarily due to higher unit sales . overall unit sales increased 25 % . our international orders may be subject to significant fluctuation over time . such orders may fluctuate due to health initiatives at various times as well as economic conditions . cost of manufactured product increased $ 4.1 million principally due to an increase in units sold . royalty expense increased $ 506 thousand due to increased gross sales . gross profit margins increased from 30.7 % in 2018 to 33.8 % in 2019 principally due to an overall increase in sales . operating expenses decreased 5.5 % from the prior year due to cost cutting measures in the fourth quarter of 2018. these decreases were partially offset by increases in other operating costs . the loss from operations was $ 1.3 million in 2018 compared to income from operations of $ 3.0 million in 2019. cash flow from operations was $ 2.2 million in 2019 due to our net income for the year . the increase in cash was offset by an increase in accounts receivable

