Humana Inc.  NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued) Our U. S.  income tax returns for 2007 and 2008 are currently under examination by the Internal Revenue Service (IRS).
Beginning with the 2009 tax year, as well as 2010, we are participating in the Compliance Assurance Process (CAP) with the IRS.
Under CAP, the IRS does advance reviews during the tax year and as the return is being prepared for filing, thereby reducing the need for post-filing examinations.
We expect the IRS will conclude its audits of the 2007, 2008, 2009 and 2010 tax years during 2011.
As of December 31, 2010, we are not aware of any material adjustments the IRS may propose.11.
DEBT The carrying value of long-term debt outstanding was as follows at December 31, 2010 and 2009:
## Table 0 ##
Senior Notes Our senior notes, which are unsecured, may be redeemed at our option at any time at 100% of the principal amount plus accrued interest and a specified make-whole amount.
The 7.20% and 8.15% senior notes are subject to an interest rate adjustment if the debt ratings assigned to the notes are downgraded (or subsequently upgraded) and contain a change of control provision that may require us to purchase the notes under certain circumstances.
We had been parties to interest-rate swap agreements to exchange the fixed interest rate under our senior notes for a variable interest rate based on LIBOR.
As a result, the carrying value of the senior notes had been adjusted to reflect changes in value caused by an increase or decrease in interest rates.
During 2008, we terminated all of our swap agreements.
The cumulative adjustment to the carrying value of our senior notes was $103.4 million as of the termination date which is being amortized as a reduction to interest expense over the remaining term of the senior notes, resulting in a weighted-average effective interest rate fixed at 6.08%.
The unamortized carrying value adjustment was $83.8 million as of December 31, 2010 and $92.9 million as of December 31, 2009.  Credit Agreement In December 2010, we replaced our 5-year $1.0 billion unsecured revolving credit agreement which was set to expire in July 2011 with a 3-year $1.0 billion unsecured revolving agreement expiring December 2013.
Under the new credit agreement, at our option, we can borrow on either a competitive advance basis or a revolving credit basis.
The revolving credit portion bears interest at either LIBOR or the base rate plus a spread.
The spread, currently 200 basis points, varies depending on our credit ratings ranging from 150 to 262.5 basis points.
We also pay an annual facility fee regardless of utilization.
This facility fee, currently 37.5 basis points, may fluctuate between 25 and 62.5 basis points, depending upon our credit ratings.
The competitive advance portion of any borrowings will bear interest at market rates prevailing at the time of borrowing on either a fixed rate or a floating rate based on LIBOR, at our option.
Humana Inc.  NOTES TO CONSOLIDATED FINANCIAL STATEMENTS—(Continued) contribution direction.
Based on the closing price of our common stock of $54.74 on December 31, 2010, approximately 14% of the retirement and savings plan’s assets were invested in our common stock, or approximately 4.1 million shares, representing 2% of the shares outstanding as of December 31, 2010.
At December 31, 2010, approximately 7.2 million shares of our common stock were reserved for issuance under our defined contribution retirement and savings plans.
Stock-Based Compensation We have plans under which options to purchase our common stock and restricted stock awards have been granted to executive officers, directors and key employees.
The terms and vesting schedules for stock-based awards vary by type of grant.
Generally, the awards vest upon time-based conditions.
The stock awards of retirement-eligible participants granted on or after January 1, 2010 will continue to vest upon retirement from the Company.
Our equity award program includes a retirement provision that treats all employees with a combination of age and years of service with the Company totaling 65 or greater, with a minimum required age of 55 and a minimum requirement of 5 years of service, as retirement-eligible.
Upon exercise, stock-based compensation awards are settled with authorized but unissued company stock.
The compensation expense that has been charged against income for these plans was as follows for the years ended December 31, 2010, 2009, and 2008:
## Table 1 ##
The tax benefit recognized in our consolidated financial statements is based on the amount of compensation expense recorded for book purposes.
The actual tax benefit realized in our tax return is based on the intrinsic value, or the excess of the market value over the exercise or purchase price, of stock options exercised and restricted stock awards vested during the period.
The actual tax benefit realized for the deductions taken on our tax returns from option exercises and restricted stock award vesting totaled $14.9 million in 2010, $16.3 million in 2009, and $16.9 million in 2008.
There was no capitalized stock-based compensation expense.
The stock plans provide that one restricted share is equivalent to 1.7 stock options.
At December 31, 2010, there were 12,375,233 shares reserved for stock award plans, including 3,225,299 shares of common stock available for future grants assuming all stock options or 1,897,235 shares available for future grants assuming all restricted shares.
Stock Options Stock options are granted with an exercise price equal to the fair market value of the underlying common stock on the date of grant.
Our stock plans, as approved by the Board of Directors and stockholders, define fair market value as the average of the highest and lowest composite stock prices reported by the New York Stock Exchange on a given date.
Exercise provisions vary, but most options vest in whole or in part 1 to 3 years after grant and expire 7 to 10 years after grant.
Upon grant, stock options are assigned a fair value based on the BlackScholes valuation model.
Compensation expense is recognized on a straight-line basis over the total requisite service period, generally the total vesting period, for the entire award.
For stock options granted on or after
The detail of benefits payable was as follows at December 31, 2010, 2009 and 2008
## Table 2 ##
(1) IBNR represents an estimate of benefits payable for claims incurred but not reported (IBNR) at the balance sheet date.
The level of IBNR is primarily impacted by membership levels, medical claim trends and the receipt cycle time, which represents the length of time between when a claim is initially incurred and when the claim form is received (i. e.  a shorter time span results in a lower IBNR).
(2) Military services benefits payable primarily results from the timing of the cost of providing health care services to beneficiaries and the payment to the provider.
A corresponding receivable for reimbursement by the federal government is included in the base receivable in the receivables table that follows.
(3) Reported claims in process represents the estimated valuation of processed claims that are in the post claim adjudication process, which consists of administrative functions such as audit and check batching and handling, as well as amounts owed to our pharmacy benefit administrator which fluctuate due to bi-weekly payments and the month-end cutoff.
(4) Other benefits payable include amounts owed to providers under capitated and risk sharing arrangements.
The increase in benefits payable in 2010 and 2009 primarily was due to an increase in amounts owed to providers under capitated and risk sharing arrangements as well as an increase in IBNR, both primarily as a result of Medicare Advantage membership growth, partially offset by a decrease in the amount of processed but unpaid claims, including pharmacy claims, which fluctuate due to the month-end cutoff.
The increase in benefits payable in 2008 primarily was due to the increase in IBNR from growth in Medicare Advantage members and, to a lesser extent, benefit claims inflation, an increase in the amount of processed but unpaid claims, including pharmacy claims, which fluctuate due to month-end cutoff, and an increase in amounts owed to providers under capitated and risk sharing arrangements from Medicare Advantage membership growth.
The detail of total net receivables was as follows at December 31, 2010, 2009 and 2008:
## Table 3 ##
The completion factor method is used for the months of incurred claims prior to the most recent three months because the historical percentage of claims processed for those months is at a level sufficient to produce a consistently reliable result.
Conversely, for the most recent three months of incurred claims, the volume of claims processed historically is not at a level sufficient to produce a reliable result, which therefore requires us to examine historical trend patterns as the primary method of evaluation.
Changes in claim processes, including receipt cycle times, claim inventory levels, recoveries of overpayments, outsourcing, system conversions, and processing disruptions due to weather or other events affect views regarding the reasonable choice of completion factors.
The receipt cycle time measures the average length of time between when a medical claim was initially incurred and when the claim form was received.
Increased electronic claim submissions from providers have decreased the receipt cycle time over the last few years.
For example, the average receipt cycle time has decreased from 15.0 days in 2008 to 13.8 days in 2010 which represents an 8.0% reduction in cycle time over the three year period.
If claims are submitted or processed on a faster (slower) pace than prior periods, the actual claim may be more (less) complete than originally estimated using our completion factors, which may result in reserves that are higher (lower) than required.
Medical cost trends potentially are more volatile than other segments of the economy.
The drivers of medical cost trends include increases in the utilization of hospital facilities, physician services, new higher priced technologies and medical procedures, and new prescription drugs and therapies, as well as the inflationary effect on the cost per unit of each of these expense components.
Other external factors such as government-mandated benefits or other regulatory changes, the tort liability system, increases in medical services capacity, direct to consumer advertising for prescription drugs and medical services, an aging population, lifestyle changes including diet and smoking, catastrophes, and epidemics also may impact medical cost trends.
Internal factors such as system conversions, claims processing cycle times, changes in medical management practices and changes in provider contracts also may impact our ability to accurately predict estimates of historical completion factors or medical cost trends.
All of these factors are considered in estimating IBNR and in estimating the per member per month claims trend for purposes of determining the reserve for the most recent three months.
Additionally, we continually prepare and review follow-up studies to assess the reasonableness of the estimates generated by our process and methods over time.
The results of these studies are also considered in determining the reserve for the most recent three months.
Each of these factors requires significant judgment by management.
The completion and claims per member per month trend factors are the most significant factors impacting the IBNR estimate.
The portion of IBNR estimated using completion factors for claims incurred prior to the most recent three months is generally less variable than the portion of IBNR estimated using trend factors.
The following table illustrates the sensitivity of these factors assuming moderate adverse experience and the estimated potential impact on our operating results caused by reasonably likely changes in these factors based on December 31, 2010 data:
## Table 4 ##
(a) Reflects estimated potential changes in benefits payable at December 31, 2010 caused by changes in completion factors for incurred months prior to the most recent three months.
Selling, general and administrative expenses increased $286.7 million to $1,158.3 million in 2014 from $871.6 million in 2013.
As a percentage of net revenues, selling, general and administrative expenses increased to 37.5% in 2014 from 37.3% in 2013.
These changes were primarily attributable to the following: ?
Marketing costs increased $86.5 million to $333.0 million in 2014 from $246.5 million in 2013 primarily due to increased global sponsorship of professional teams and athletes.
As a percentage of net revenues, marketing costs increased to 10.8% in 2014 from 10.5%.  ?
Other costs increased increased $200.2 million to $825.3 million in 2014 from $625.1 million in 2013.
This increase was primarily due to higher personnel and other costs incurred for the continued expansion of our direct to consumer distribution channel, including increased investment for our brand house stores.
This increase was also due to additional investment in our Connected Fitness business.
As a percentage of net revenues, other costs were unchanged at 26.8% in 2014 and 2013.
Income from operations increased $88.9 million, or 33.5%, to $354.0 million in 2014 from $265.1 million in 2013.
Income from operations as a percentage of net revenues increased to 11.5% in 2014 from 11.4% in 2013.
Interest expense, net increased $2.4 million to $5.3 million in 2014 from $2.9 million in 2013.
This increase was primarily due to the $150.0 million and $100.0 million term loans borrowed during 2014.
Other expense, net increased $5.2 million to $6.4 million in 2014 from $1.2 million in 2013.
This increase was due to higher net losses in 2014 on the combined foreign currency exchange rate changes on transactions denominated in foreign currencies and our foreign currency derivative financial instruments as compared to 2013.
Provision for income taxes increased $35.5 million to $134.2 million in 2014 from $98.7 million in 2013.
Our effective tax rate was 39.2% in 2014 compared to 37.8% in 2013.
Our effective tax rate for 2014 was higher than the effective tax rate for 2013 primarily due to increased foreign investments driving a lower proportion of foreign taxable income in 2014 and state tax credits received in 2013.
Segment Results of Operations The net revenues and operating income (loss) associated with our segments are summarized in the following tables.
The majority of corporate expenses within North America have not been allocated to international or Connected Fitness; however, certain costs and revenues included within North America in the prior period have been allocated to Connected Fitness in the current period.
Prior period segment data has been recast by an immaterial amount within the tables to conform to the current period presentation.
Year Ended December 31, 2015 Compared to Year Ended December 31, 2014 Net revenues by segment are summarized below:

<table><tr><td></td><td> 2010</td><td> 2009</td></tr><tr><td></td><td colspan="2"> (in thousands)</td></tr><tr><td>Long-term debt:</td><td></td><td></td></tr><tr><td>Senior notes:</td><td></td><td></td></tr><tr><td>$500 million, 6.45% due June 1, 2016</td><td>$535,342</td><td>$540,907</td></tr><tr><td>$500 million, 7.20% due June 15, 2018</td><td>508,005</td><td>508,799</td></tr><tr><td>$300 million, 6.30% due August 1, 2018</td><td>321,622</td><td>323,862</td></tr><tr><td>$250 million, 8.15% due June 15, 2038</td><td>266,892</td><td>267,070</td></tr><tr><td>Total senior notes</td><td>1,631,861</td><td>1,640,638</td></tr><tr><td>Other long-term borrowings</td><td>36,988</td><td>37,528</td></tr><tr><td>Total long-term debt</td><td>$1,668,849</td><td>$1,678,166</td></tr></table>
<table><tr><td></td><td>2010</td><td>2009</td><td>2008</td></tr><tr><td></td><td colspan="3">(in thousands)</td></tr><tr><td>Stock-based compensation expense by type:</td><td></td><td></td><td></td></tr><tr><td>Stock options</td><td>$21,757</td><td>$19,555</td><td>$18,202</td></tr><tr><td>Restricted stock awards</td><td>41,190</td><td>46,315</td><td>37,167</td></tr><tr><td>Total stock-based compensation expense</td><td>62,947</td><td>65,870</td><td>55,369</td></tr><tr><td>Tax benefit recognized</td><td>-23,057</td><td>-24,128</td><td>-20,282</td></tr><tr><td>Stock-based compensation expense, net of tax</td><td>$39,890</td><td>$41,742</td><td>$35,087</td></tr></table>
<table><tr><td></td><td></td><td></td><td></td><td colspan="2">Change</td></tr><tr><td></td><td> 2010</td><td> 2009</td><td> 2008</td><td>2010</td><td>2009</td></tr><tr><td></td><td colspan="5">(in thousands)</td></tr><tr><td>IBNR -1</td><td>$2,051,227</td><td>$1,902,700</td><td>$1,851,047</td><td>$148,527</td><td>$51,653</td></tr><tr><td>Military services benefits payable -2</td><td>255,180</td><td>279,195</td><td>306,797</td><td>-24,015</td><td>-27,602</td></tr><tr><td>Reported claims in process -3</td><td>136,803</td><td>357,718</td><td>486,514</td><td>-220,915</td><td>-128,796</td></tr><tr><td>Other benefits payable -4</td><td>1,026,096</td><td>682,961</td><td>561,221</td><td>343,135</td><td>121,740</td></tr><tr><td>Total benefits payable</td><td>$3,469,306</td><td>$3,222,574</td><td>$3,205,579</td><td>$246,732</td><td>$16,995</td></tr></table>
<table><tr><td></td><td></td><td></td><td></td><td colspan="2">Change</td></tr><tr><td></td><td>2010</td><td>2009</td><td>2008</td><td>2010</td><td>2009</td></tr><tr><td></td><td colspan="5">(in thousands)</td></tr><tr><td>Military services:</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Base receivable</td><td>$424,786</td><td>$451,248</td><td>$436,009</td><td>$-26,462</td><td>$15,239</td></tr><tr><td>Change orders</td><td>2,052</td><td>2,024</td><td>6,190</td><td>28</td><td>-4,166</td></tr><tr><td>Military services subtotal</td><td>426,838</td><td>453,272</td><td>442,199</td><td>-26,434</td><td>11,073</td></tr><tr><td>Medicare</td><td>216,080</td><td>238,056</td><td>232,608</td><td>-21,976</td><td>5,448</td></tr><tr><td>Commercial and other</td><td>367,570</td><td>183,124</td><td>164,035</td><td>184,446</td><td>19,089</td></tr><tr><td>Allowance for doubtful accounts</td><td>-51,470</td><td>-50,832</td><td>-49,160</td><td>-638</td><td>-1,672</td></tr><tr><td>Total net receivables</td><td>$959,018</td><td>$823,620</td><td>$789,682</td><td>135,398</td><td>33,938</td></tr><tr><td>Reconciliation to cash flow statement:</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Provision for doubtful accounts</td><td></td><td></td><td></td><td>18,708</td><td>19,054</td></tr><tr><td>Receivables from acquisition</td><td></td><td></td><td></td><td>-108,571</td><td>6,974</td></tr><tr><td>Change in receivables per cash flow statement resulting in cash from operations</td><td></td><td></td><td></td><td>$45,535</td><td>$59,966</td></tr></table>
<table><tr><td colspan="2">Completion Factor (a):</td><td colspan="2">Claims Trend Factor (b):</td></tr><tr><td> Factor Change (c)</td><td>Decrease in Benefits Payable</td><td>Factor Change (c)</td><td>Decrease in Benefits Payable</td></tr><tr><td colspan="4">(dollars in thousands)</td></tr><tr><td>1.25%</td><td>$-184,444</td><td>-5.00%</td><td>$-249,764</td></tr><tr><td>1.10%</td><td>$-162,310</td><td>-4.25%</td><td>$-212,299</td></tr><tr><td>0.95%</td><td>$-140,177</td><td>-3.50%</td><td>$-174,835</td></tr><tr><td>0.80%</td><td>$-118,044</td><td>-2.75%</td><td>$-137,370</td></tr><tr><td>0.65%</td><td>$-95,911</td><td>-2.00%</td><td>$-99,906</td></tr><tr><td>0.50%</td><td>$-73,777</td><td>-1.25%</td><td>$-62,441</td></tr><tr><td>0.35%</td><td>$-51,644</td><td>-0.25%</td><td>$-12,488</td></tr></table>

Question: What's the total value of all elements that are smaller than 200000 in 2008? (in thousand)
Answer: 121065