10. Restructuring and Related Charges and Impairment Loss

In December 2012, we began a restructuring of the Company (the "2012 Restructuring"), which was largely completed by the end of 2012, primarily focused on capacity realignment. Through December 31, 2012, we had incurred cumulative net cash and non-cash charges of approximately $1.8 million related to this restructuring, which primarily consisted of one-time termination benefits. For the year ended December 31, 2012, these charges were presented as a separate line item in the consolidated statement of operations. We do not expect to incur significant additional costs or adjustments related to this restructuring.

In November 2011, we began a restructuring of the Company (the "2011 Restructuring"), which was largely completed by the end of 2011, primarily focused on aligning our capacity requirements and organizational structure following CIGNA's decision to wind-down its contract beginning in 2012. The majority of these charges were presented as a separate line item in the consolidated statement of operations. We do not expect to incur significant additional costs or adjustments related to this restructuring.

In November 2010, we began a restructuring of the Company (the "2010 Restructuring"), which was largely completed by the end of 2010, primarily focused on aligning resources with current and emerging markets and consolidating operating capacity. The majority of these charges were presented as a separate line item in the consilidated statement of operations. We do not expect to incur significant additional costs or adjustments related to this restructuring.

The change in accrued restructuring and related charges related to the 2012 Restructuring, 2011 Restructuring, and 2010 Restructuring activities described above during the year ended December 31, 2012 were as follows:

(In thousands)	2012		2011				2010
	Restructuring		Restructuring (1)				Restructuring ₍₂₎				Total
Accreued restructuring and related charges at December 31, 2009		—		—				—				—
Additions		—		—				8,507				8,507
Payments		—		—				(900	)			(900)
Adjustments		—		—				—				—
Accrued restructuring and related charges at December 31, 2010		—		—				7,607				7,607
Additions		—		8,430				—				8,430
Payments		—		(4)				(5,124	)			(5,128	)
Adjustments		—		—				(900	)	(3)		(900)
Accrued restructuring and related charges at December 31, 2011	$	—	$	8,426			$	1,583			$	10,009
Additions		1,773		—				—				1,773
Payments		—		(7,368	)			(822	)			(8,190	)
Adjustments		—		(504	)	(4)		(132	)	(3)		(636	)
Accrued restructuring and related charges at December 31, 2012	$	1,773	$	554			$	629				2,956

(1)	Excludes non-cash charges of approximately $0.6 million, which primarily consisted of share-based compensation costs

(2)	Excludes non-cash charges of approximately $1.8 million, which primarily consisted of share-based compensation costs.

(3)	Adjustments resulted primarily from a favorable adjustment to lease termination costs due to a sublease of certain unused office space.

(4)	Adjustments resulted primarily from actual employee tax and benefit amounts differing from previous estimates.

In December 2011, we recorded an impairment loss of $183.3 million which consisted of a goodwill impairment loss of $182.4 million (see Note 3) and an intangible asset write-off of $0.9 million (see Note 4).