3. Goodwill

The change in carrying amount of goodwill during the years ended December 31, 2010, 2011, and 2012 is shown below:

(In thousands)
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
Ascentia purchase		3,303
Balance, December 31, 2012	$	338,695

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 2010, we recorded a purchase price adjustment related to this acquisition of $0.2 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 were valued in the aggregate at $3.3 million.

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

In April 2012, we acquired Ascentia Health Care Solutions ("Ascentia"), a firm that supports and promotes population health management, patient centered programs, payer strategies and physician practice enhancement programs, for $5.5 million in cash. In addition, we issued 14,409 unregistered shares of our common stock which were valued in the aggregate at $0.1 million.