Goodwill

The change in carrying amount of goodwill during the years ended December 31, 2011, 2012, and 2013 is shown below:

(In thousands)
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
Other adjustments		105
Balance, December 31, 2013	$	338,800

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, 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.

As of January 1, 2013, the gross amount of goodwill totaled $521.1 million, and we had accumulated impairment losses of $182.4 million.