3. Goodwill

The change in carrying amount of goodwill during the years ended December 31, 2009, 2010, and 2011 is shown below:

(In $000s)
Balance, December 31, 2008	$	484,596
HealthHonors purchase		11,850
Balance, December 31, 2009		496,446
HealthHonors purchase price adjustment		(181	)
Balance, December 31, 2010		496,265
Navvis purchase		21,527
Impairment loss		(182,400	)
Balance, December 31, 2011	$	335,392

In October 2009, we acquired HealthHonors, a behavioral economics company that specializes in behavior change science and optimized use of incentives, for a net cash payment of $14.5 million and a multi-year earn-out arrangement with an acquisition date fair value of $3.0 million.

In August 2011, we acquired Navvis & Company (“Navvis”), a firm that provides strategic counsel and change management services to healthcare systems for $23.7 million in cash. In addition, we issued 432,902 unregistered shares of our common stock which was valued in aggregate at $3.3 million.

As a result of changes in our long-term projections related to the wind-down of our contract with CIGNA, we performed a quantitative goodwill impairment review during the fourth quarter of 2011 (see Note 7) and recorded a $182.4 million goodwill impairment loss.