the medicare advantage rate structure is changing and funding has been cut in recent years , with additional reductions to take effect in 2015 , as discussed below in “ regulatory trends and uncertainties . ” we are taking actions to respond to these funding reductions , but the reductions adversely affected after-tax earnings for our medicare business during 2014 , and we expect our 29 2015 medicare mlr to be slightly higher than in 2014. we expect continued medicaid revenue increases due to anticipated growth in our offerings ; we also believe that the reimbursement rate environment creates the risk of downward pressure on medicaid net margin percentages . we continue to take a prudent , market-sustainable posture for both new business and maintenance of existing relationships . we advocate for actuarially sound rates that are commensurate with our medical cost trends and remain dedicated to partnering with those states that are committed to the long-term viability of their programs . medical cost trends . our medical cost trends are primarily related to unit costs , utilization and prescription drug costs . consistent with our experience in recent years , our 2014 cost trends were largely driven by continued unit cost pressure from health care providers . although the weak economic environment combined with our medical cost management strategies has had a favorable impact on utilization trends in recent years , the impacts of health reform legislation , namely mandated essential health benefits and limits on out-of-pocket maximums , are exerting upward pressure on medical cost trends . the primary drivers of prescription drug trends continue to be unit cost pressure on brand name drugs and a shift towards expensive new specialty medications , including new hepatitis c therapies . delivery system and payment modernization . the health care market continues to change based on demographic shifts , new regulations , political forces and both payer and patient expectations . health plans and care providers are being called upon to work together to close gaps in care and improve overall care quality , improve the health of populations and reduce costs . delivery system modernization and payment reform are critical and the alignment of incentives between key constituents remains an important theme . we are increasingly rewarding care providers for delivering improvements in quality and cost-efficiency . as of december 31 , 2014 , we served nearly 3 million people through the most progressive of these arrangements , including full-risk , shared-risk and bundled episode-of-care payment approaches . as of december 31 , 2014 , our contracts with value based spending total nearly $ 37 billion annually , up significantly from recent years . this trend is creating needs for health management services that can coordinate care around the primary care physician , including new primary care channels , and for investments in new clinical and administrative information and management systems , which we believe provide growth opportunities for our optum business platform . regulatory trends and uncertainties following is a summary of management 's view of the trends and uncertainties related to some of the key provisions of health reform legislation and other regulatory items . for additional information regarding health reform legislation and regulatory trends and uncertainties , see part i , item 1 “ business - government regulation ” and item 1a , “ risk factors . ” medicare advantage rates and minimum loss ratios . medicare advantage rates have been cut over the last several years , with additional funding reductions to be phased-in through 2017 as a result of ( a ) changes to cms medicare advantage benchmark rates ; ( b ) health reform legislation ; and ( c ) the budget control act of 2011 , as amended by the american taxpayer relief act of 2012 , which reduced medicare advantage and medicare part d payments ( sequestration ) . the cms final notice of 2015 medicare advantage benchmark rates and payment policies includes additional significant reductions for 2015. these industry level reductions , including the impact of the industry tax described below , resulted in revenue reductions and incremental assessments totaling more than 6 % of revenue in 2014 and more than an additional 3 % in 2015 , against a typical industry forward medical cost trend of 3 % . the impact of these cuts to our medicare advantage revenues is partially mitigated by reductions in provider reimbursements for those care providers with rates indexed to medicare advantage revenues or medicare fee-for-service reimbursement rates . these factors affected our plan benefit designs , market participation , growth prospects and expectation of earnings for our medicare advantage plans for 2015. health reform legislation directed hhs to establish a program to reward high-quality medicare advantage plans beginning in 2012. our medicare advantage rates are currently enhanced by cms quality bonuses in certain counties based on our local plans ' star ratings . the level of star ratings from cms , based upon specified clinical and operational performance standards , will impact future quality bonuses . in addition , star ratings affect the amount of savings a plan has to generate to offer supplemental benefits , which ultimately may affect the plan 's membership and revenue . the historical expanded star bonus program , which paid bonuses to qualifying plans rated 3 stars or higher expired after 2014. in 2015 , quality bonus payments will be paid only to plans rated 4 stars and higher . for the 2015 star bonus payment year , more than 37 % of our medicare advantage members are enrolled in plans rated 4 stars or higher . we currently expect a similar percentage of members to be enrolled in such plans for the 2016 payment year . we are dedicating substantial resources to advance our quality scores and star ratings to strengthen our local market programs and further improve our performance for the 2017 and 2018 payment years . story_separator_special_tag for the twelve months ended december 31 , 2013 , our u.s. regulated subsidiaries paid their parent companies dividends of $ 3.2 billion . see note 10 of notes to the consolidated financial statements included in part ii , item 8 , “ financial statements ” for further detail concerning our regulated subsidiary dividends . our nonregulated businesses also generate cash flows from operations that are available for general corporate use . cash flows generated by these entities , combined with dividends from our regulated entities and financing through the issuance of long-term debt as well as issuance of commercial paper or the ability to draw under our committed credit facilities , further strengthen our operating and financial flexibility . we use these cash flows to expand our businesses through acquisitions , reinvest in our businesses through capital expenditures , repay debt , and return capital to our shareholders through shareholder dividends and or repurchases of our common stock , depending on market conditions . 37 summary of our major sources and uses of cash and cash equivalents replace_table_token_9_th 2014 cash flows compared to 2013 cash flows cash flows provided by operating activities in 2014 increased primarily due to an increased level of accounts payable and other liabilities including the collection of reinsurance program fees in advance of remittance in 2015 , partially offset by an increase in government receivables . other significant changes in sources or uses of cash year-over-year included : ( a ) a change in investment activity from net purchases in 2013 to net sales in 2014 ; ( b ) an increase in part d subsidy receivables causing a change in customer funds administered ; and ( c ) increased levels of cash used to repurchase common stock . 2013 cash flows compared to 2012 cash flows cash flows provided by operating activities in 2013 decreased due to the net effects of changes in operating assets and liabilities , including : ( a ) an increase in pharmacy rebates receivables stemming from the increased membership at optumrx , the effects of which were partially offset by ( b ) increases in medical costs payable due to the growth in the number of individuals served in our public and senior markets and international businesses . other significant items contributing to the overall decrease in cash year-over-year included : ( a ) decreased investments in acquisitions and noncontrolling interest shares ( the activity in 2013 primarily related to the acquisition of the remaining publicly traded shares of amil during the second quarter of 2013 for $ 1.5 billion ) ; ( b ) a decrease in net proceeds from commercial paper and long-term debt , as proceeds from 2013 debt issuances were fully offset by scheduled maturities and the redemption of all of our outstanding subsidiary debt ( in 2012 , the increased cash flows from common stock issuances and proceeds from issuances of commercial paper and long-term debt primarily related to the amil acquisition ) ; and ( c ) increased net purchases of investments . financial condition as of december 31 , 2014 , our cash , cash equivalent and available-for-sale investment balances of $ 27.6 billion included $ 7.5 billion of cash and cash equivalents ( of which $ 738 million was available for general corporate use ) , $ 18.6 billion story_separator_special_tag off-balance sheet arrangements as of december 31 , 2014 , we were not involved in any off-balance sheet arrangements , which have or are reasonably likely to have a material effect on our financial condition , results of operations or liquidity . recently issued accounting standards in may 2014 , the financial accounting standards board issued asu no . 2014-09 “ revenue from contracts with customers ( topic 606 ) . ” asu 2014-09 will supersede existing revenue recognition standards with a single model unless those contracts are within the scope of other standards ( e.g . , an insurance entity 's insurance contracts ) . the revenue recognition principle in asu 2014-09 is that an entity should recognize revenue to depict the transfer of goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services . in addition , new and enhanced disclosures will be required . companies can adopt the new standard using either the full retrospective approach , a modified retrospective approach with practical expedients , or a cumulative effect upon adoption approach . asu 2014-09 will become effective for annual and interim reporting periods beginning after december 15 , 2016. early adoption is not permitted . we are currently evaluating the effect of the new revenue recognition guidance . 40 we have determined that there have been no other recently issued , but not yet adopted , accounting standards that will have a material impact on our consolidated financial statements . critical accounting estimates critical accounting estimates are those estimates that require management to make challenging , subjective or complex judgments , often because they must estimate the effects of matters that are inherently uncertain and may change in subsequent periods . critical accounting estimates involve judgments and uncertainties that are sufficiently sensitive and may result in materially different results under different assumptions and conditions . medical costs payable each reporting period , we estimate our obligations for medical care services that have been rendered on behalf of insured consumers but for which claims have either not yet been received or processed and for liabilities for physician , hospital and other medical cost disputes . we develop estimates for medical care services incurred but not reported using an actuarial process that is consistently applied , centrally controlled and automated . the actuarial models consider factors such as time from date of service to claim receipt , claim processing backlogs , seasonal variances in medical care consumption , health care professional contract rate changes , medical care utilization and other medical cost

of debt 38 securities and $ 1.5 billion of investments in equity securities consisting of investments in non-u.s. dollar fixed-income funds ; employee savings plan related investments ; venture capital funds ; and dividend paying stocks . given the significant portion of our portfolio held in cash equivalents , we do not anticipate fluctuations in the aggregate fair value of our financial assets to have a material impact on our liquidity or capital position . the use of different market assumptions or valuation methodologies , especially those used in valuing our $ 384 million of available-for-sale level 3 securities ( those securities priced using significant unobservable inputs ) , may have an effect on the estimated fair values of our investments . due to the subjective nature of these assumptions , the estimates may not be indicative of the actual exit price if we had sold the investment at the measurement date . other sources of liquidity , primarily from operating cash flows and our commercial paper program , which is supported by our bank credit facilities , reduce the need to sell investments during adverse market conditions . see note 4 of notes to the consolidated financial statements included in part ii , item 8 , “ financial statements ” for further detail concerning our fair value measurements . our available-for-sale debt portfolio had a weighted-average duration of 3.4 years and a weighted-average credit rating of “ aa ” as of december 31 , 2014 . when multiple credit ratings are available for an individual security , the average of the available ratings is used to determine the weighted-average credit rating . capital resources and uses of liquidity in addition to cash flows from operations and cash and cash equivalent balances available for general corporate use , our capital resources and uses of liquidity are as follows : commercial paper and bank credit facilities . our bank credit facilities provide liquidity support for our commercial paper borrowing program , which facilitates the private placement of unsecured debt through third-party broker-dealers , and are available for general corporate purposes .


 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.
     ```of debt 38 securities and $ 1.5 billion of investments in equity securities consisting of investments in non-u.s. dollar fixed-income funds ; employee savings plan related investments ; venture capital funds ; and dividend paying stocks . given the significant portion of our portfolio held in cash equivalents , we do not anticipate fluctuations in the aggregate fair value of our financial assets to have a material impact on our liquidity or capital position . the use of different market assumptions or valuation methodologies , especially those used in valuing our $ 384 million of available-for-sale level 3 securities ( those securities priced using significant unobservable inputs ) , may have an effect on the estimated fair values of our investments . due to the subjective nature of these assumptions , the estimates may not be indicative of the actual exit price if we had sold the investment at the measurement date . other sources of liquidity , primarily from operating cash flows and our commercial paper program , which is supported by our bank credit facilities , reduce the need to sell investments during adverse market conditions . see note 4 of notes to the consolidated financial statements included in part ii , item 8 , “ financial statements ” for further detail concerning our fair value measurements . our available-for-sale debt portfolio had a weighted-average duration of 3.4 years and a weighted-average credit rating of “ aa ” as of december 31 , 2014 . when multiple credit ratings are available for an individual security , the average of the available ratings is used to determine the weighted-average credit rating . capital resources and uses of liquidity in addition to cash flows from operations and cash and cash equivalent balances available for general corporate use , our capital resources and uses of liquidity are as follows : commercial paper and bank credit facilities . our bank credit facilities provide liquidity support for our commercial paper borrowing program , which facilitates the private placement of unsecured debt through third-party broker-dealers , and are available for general corporate purposes .
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 Suspicious Activity Report : the medicare advantage rate structure is changing and funding has been cut in recent years , with additional reductions to take effect in 2015 , as discussed below in “ regulatory trends and uncertainties . ” we are taking actions to respond to these funding reductions , but the reductions adversely affected after-tax earnings for our medicare business during 2014 , and we expect our 29 2015 medicare mlr to be slightly higher than in 2014. we expect continued medicaid revenue increases due to anticipated growth in our offerings ; we also believe that the reimbursement rate environment creates the risk of downward pressure on medicaid net margin percentages . we continue to take a prudent , market-sustainable posture for both new business and maintenance of existing relationships . we advocate for actuarially sound rates that are commensurate with our medical cost trends and remain dedicated to partnering with those states that are committed to the long-term viability of their programs . medical cost trends . our medical cost trends are primarily related to unit costs , utilization and prescription drug costs . consistent with our experience in recent years , our 2014 cost trends were largely driven by continued unit cost pressure from health care providers . although the weak economic environment combined with our medical cost management strategies has had a favorable impact on utilization trends in recent years , the impacts of health reform legislation , namely mandated essential health benefits and limits on out-of-pocket maximums , are exerting upward pressure on medical cost trends . the primary drivers of prescription drug trends continue to be unit cost pressure on brand name drugs and a shift towards expensive new specialty medications , including new hepatitis c therapies . delivery system and payment modernization . the health care market continues to change based on demographic shifts , new regulations , political forces and both payer and patient expectations . health plans and care providers are being called upon to work together to close gaps in care and improve overall care quality , improve the health of populations and reduce costs . delivery system modernization and payment reform are critical and the alignment of incentives between key constituents remains an important theme . we are increasingly rewarding care providers for delivering improvements in quality and cost-efficiency . as of december 31 , 2014 , we served nearly 3 million people through the most progressive of these arrangements , including full-risk , shared-risk and bundled episode-of-care payment approaches . as of december 31 , 2014 , our contracts with value based spending total nearly $ 37 billion annually , up significantly from recent years . this trend is creating needs for health management services that can coordinate care around the primary care physician , including new primary care channels , and for investments in new clinical and administrative information and management systems , which we believe provide growth opportunities for our optum business platform . regulatory trends and uncertainties following is a summary of management 's view of the trends and uncertainties related to some of the key provisions of health reform legislation and other regulatory items . for additional information regarding health reform legislation and regulatory trends and uncertainties , see part i , item 1 “ business - government regulation ” and item 1a , “ risk factors . ” medicare advantage rates and minimum loss ratios . medicare advantage rates have been cut over the last several years , with additional funding reductions to be phased-in through 2017 as a result of ( a ) changes to cms medicare advantage benchmark rates ; ( b ) health reform legislation ; and ( c ) the budget control act of 2011 , as amended by the american taxpayer relief act of 2012 , which reduced medicare advantage and medicare part d payments ( sequestration ) . the cms final notice of 2015 medicare advantage benchmark rates and payment policies includes additional significant reductions for 2015. these industry level reductions , including the impact of the industry tax described below , resulted in revenue reductions and incremental assessments totaling more than 6 % of revenue in 2014 and more than an additional 3 % in 2015 , against a typical industry forward medical cost trend of 3 % . the impact of these cuts to our medicare advantage revenues is partially mitigated by reductions in provider reimbursements for those care providers with rates indexed to medicare advantage revenues or medicare fee-for-service reimbursement rates . these factors affected our plan benefit designs , market participation , growth prospects and expectation of earnings for our medicare advantage plans for 2015. health reform legislation directed hhs to establish a program to reward high-quality medicare advantage plans beginning in 2012. our medicare advantage rates are currently enhanced by cms quality bonuses in certain counties based on our local plans ' star ratings . the level of star ratings from cms , based upon specified clinical and operational performance standards , will impact future quality bonuses . in addition , star ratings affect the amount of savings a plan has to generate to offer supplemental benefits , which ultimately may affect the plan 's membership and revenue . the historical expanded star bonus program , which paid bonuses to qualifying plans rated 3 stars or higher expired after 2014. in 2015 , quality bonus payments will be paid only to plans rated 4 stars and higher . for the 2015 star bonus payment year , more than 37 % of our medicare advantage members are enrolled in plans rated 4 stars or higher . we currently expect a similar percentage of members to be enrolled in such plans for the 2016 payment year . we are dedicating substantial resources to advance our quality scores and star ratings to strengthen our local market programs and further improve our performance for the 2017 and 2018 payment years . story_separator_special_tag for the twelve months ended december 31 , 2013 , our u.s. regulated subsidiaries paid their parent companies dividends of $ 3.2 billion . see note 10 of notes to the consolidated financial statements included in part ii , item 8 , “ financial statements ” for further detail concerning our regulated subsidiary dividends . our nonregulated businesses also generate cash flows from operations that are available for general corporate use . cash flows generated by these entities , combined with dividends from our regulated entities and financing through the issuance of long-term debt as well as issuance of commercial paper or the ability to draw under our committed credit facilities , further strengthen our operating and financial flexibility . we use these cash flows to expand our businesses through acquisitions , reinvest in our businesses through capital expenditures , repay debt , and return capital to our shareholders through shareholder dividends and or repurchases of our common stock , depending on market conditions . 37 summary of our major sources and uses of cash and cash equivalents replace_table_token_9_th 2014 cash flows compared to 2013 cash flows cash flows provided by operating activities in 2014 increased primarily due to an increased level of accounts payable and other liabilities including the collection of reinsurance program fees in advance of remittance in 2015 , partially offset by an increase in government receivables . other significant changes in sources or uses of cash year-over-year included : ( a ) a change in investment activity from net purchases in 2013 to net sales in 2014 ; ( b ) an increase in part d subsidy receivables causing a change in customer funds administered ; and ( c ) increased levels of cash used to repurchase common stock . 2013 cash flows compared to 2012 cash flows cash flows provided by operating activities in 2013 decreased due to the net effects of changes in operating assets and liabilities , including : ( a ) an increase in pharmacy rebates receivables stemming from the increased membership at optumrx , the effects of which were partially offset by ( b ) increases in medical costs payable due to the growth in the number of individuals served in our public and senior markets and international businesses . other significant items contributing to the overall decrease in cash year-over-year included : ( a ) decreased investments in acquisitions and noncontrolling interest shares ( the activity in 2013 primarily related to the acquisition of the remaining publicly traded shares of amil during the second quarter of 2013 for $ 1.5 billion ) ; ( b ) a decrease in net proceeds from commercial paper and long-term debt , as proceeds from 2013 debt issuances were fully offset by scheduled maturities and the redemption of all of our outstanding subsidiary debt ( in 2012 , the increased cash flows from common stock issuances and proceeds from issuances of commercial paper and long-term debt primarily related to the amil acquisition ) ; and ( c ) increased net purchases of investments . financial condition as of december 31 , 2014 , our cash , cash equivalent and available-for-sale investment balances of $ 27.6 billion included $ 7.5 billion of cash and cash equivalents ( of which $ 738 million was available for general corporate use ) , $ 18.6 billion story_separator_special_tag off-balance sheet arrangements as of december 31 , 2014 , we were not involved in any off-balance sheet arrangements , which have or are reasonably likely to have a material effect on our financial condition , results of operations or liquidity . recently issued accounting standards in may 2014 , the financial accounting standards board issued asu no . 2014-09 “ revenue from contracts with customers ( topic 606 ) . ” asu 2014-09 will supersede existing revenue recognition standards with a single model unless those contracts are within the scope of other standards ( e.g . , an insurance entity 's insurance contracts ) . the revenue recognition principle in asu 2014-09 is that an entity should recognize revenue to depict the transfer of goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services . in addition , new and enhanced disclosures will be required . companies can adopt the new standard using either the full retrospective approach , a modified retrospective approach with practical expedients , or a cumulative effect upon adoption approach . asu 2014-09 will become effective for annual and interim reporting periods beginning after december 15 , 2016. early adoption is not permitted . we are currently evaluating the effect of the new revenue recognition guidance . 40 we have determined that there have been no other recently issued , but not yet adopted , accounting standards that will have a material impact on our consolidated financial statements . critical accounting estimates critical accounting estimates are those estimates that require management to make challenging , subjective or complex judgments , often because they must estimate the effects of matters that are inherently uncertain and may change in subsequent periods . critical accounting estimates involve judgments and uncertainties that are sufficiently sensitive and may result in materially different results under different assumptions and conditions . medical costs payable each reporting period , we estimate our obligations for medical care services that have been rendered on behalf of insured consumers but for which claims have either not yet been received or processed and for liabilities for physician , hospital and other medical cost disputes . we develop estimates for medical care services incurred but not reported using an actuarial process that is consistently applied , centrally controlled and automated . the actuarial models consider factors such as time from date of service to claim receipt , claim processing backlogs , seasonal variances in medical care consumption , health care professional contract rate changes , medical care utilization and other medical cost

