Rekapitulasi Pengembalian Income

Tahun Anggaran 2014

Bulan Pebruari dan Maret

Honor Panitia Pelaksana Kegiatan

No Puskesmas

Pebruari Maret
1 2 3 4
1 Banyumudal 9.736.000 9.202.600
2 Warungrpring 2.493.250 2.743.450
3 Watukumpul 6.196.500 9.065.950
4 Pulosari 6.012.250 6.181.450
5 Belik 15.585.550 10.532.700
6 Bantarbolang 5.673.350 7.421.950
7 Randudongkal 31.742.375 21.977.150
8 Kalimas 7.813.000 5.743.400
9 Paduraksa 9.394.600 6.494.900
10 Mulyoharjo 10.758.800 12.569.150
11 Kebondalem 8.369.950 10.409.200
12 Banjardawa 7.286.650 4.234.650
13 Kabunan 4.636.150 5.654.950
14 Jebed 5.933.200 5.628.400
15 Petarukan 24.221.300 15.767.350
16 Klareyan 6.951.400 7.380.200
17 Losari 9.585.700 5.167.750
18 Kebandaran 2.232.250 7.380.200
19 Purwoharjo 45.060.000 28.819.650
20 Sarwodadi 6.888.700 4.196.400
21 Rowosari 5.204.050 3.362.600
22 Mojo 8.739.900 5.636.550
23 DKK 65.680.313 50.160.125
Jumlah 306.195.938 240.890.275
Rekapitulasi Pengembalian Income
Tahun Anggaran 2014
Bulan Pebruari dan Maret

Jumlah

5
18.938.600
5.236.700
15.262.450
12.193.700
26.118.250
13.095.300
53.719525
13.556.400
15.889.500
23.327.950
18.779.150
11.521.300
11.291.100
11.561.600
39.988.650
14.331.600 73879650
14.753.450
9.612.450
73.879.650
11.085.100
8.566.650
14.376.450
115.840.438 547086213
547.086.213
Rekapitulasi : Pengembalian Income dan Kapitasi Askes Ke Puskesmas se Kabupaten Pemalang
Belanja Alat Tulis Kantor dan Belanja Barang/ Jasa
Bulan Desember 2013
Tahun Anggaran 2014

Belanja ATK Belanja Barang/ Jasa

No Puskesmas INCOME INCOME ASKES Jumlah Jumlah

Desember Jumlah Desember Desember Jumlah

1 Banyumudal 3,408,000 3,408,000 13,578,000 416,100 13,994,100 Rp 17,402,100
2 Warungrpring 1,978,500 1,978,500 7,121,250 159,600 7,280,850 Rp 9,259,350
3 Watukumpul 2,752,500 2,752,500 11,796,075 331,800 12,127,875 Rp 14,880,375
4 Pulosari 2,105,000 2,105,000 7,825,450 297,300 8,122,750 Rp 10,227,750
5 Belik 4,541,000 4,541,000 18,502,600 398,100 18,900,700 Rp 23,441,700
6 Bantarbolang 6,003,500 6,003,500 23,974,300 402,900 24,377,200 Rp 30,380,700
7 Randudongkal 4,605,000 4,605,000 29,606,100 946,650 30,552,750 Rp 35,157,750
8 Kalimas 4,125,000 4,125,000 12,676,550 226,800 12,903,350 Rp 17,028,350
9 Paduraksa 2,478,500 2,478,500 9,719,650 861,100 10,581,250 Rp 13,059,750
10 Mulyoharjo 1,956,500 1,956,500 8,398,150 1,626,900 10,025,050 Rp 11,981,550
11 Kebondalem 2,964,500 2,964,500 12,020,350 1,220,400 13,240,750 Rp 16,025,250
12 Banjardawa 1,833,500 1,833,500 7,456,300 933,000 8,389,300 Rp 10,222,800
13 Kabunan 3,070,000 3,070,000 11,365,850 402,000 11,767,850 Rp 14,837,850
14 Jebed 3,791,500 3,791,500 14,127,050 349,200 14,476,250 Rp 18,267,750
15 Petarukan 8,554,000 8,554,000 32,898,950 1,402,200 33,941,150 Rp 42,495,150
16 Klareyan 11,116,000 11,116,000 43,281,950 337,800 43,619,750 Rp 54,735,750
17 Losari 3,780,000 3,780,000 14,249,700 762,600 15,012,300 Rp 18,792,300
18 Kebandaran 2,283,000 2,283,000 9,620,700 388,200 10,008,900 Rp 12,291,900
19 Purwoharjo 11,106,500 11,106,500 52,614,650 1,286,850 53,901,500 Rp 65,010,000
20 Sarwodadi 2,131,500 2,131,500 8,130,300 240,300 8,370,600 Rp 10,502,100
21 Rowosari 1,560,500 1,560,500 5,774,050 - 5,774,050 Rp 7,334,550
22 Mojo 2,797,000 2,797,000 10,458,650 223,200 10,681,850 Rp 134,780,850

JUMLAH 88,943,500 88,943,500 368,296,625 12,853,500 381,150,125 Rp 470,093,625

12903350
Rekapitulasi : Pengembalian Income Ke Puskesmas se Kabupaten Pemalang
Belanja Alat Tulis Kantor dan Belanja Barang/ Jasa
Bulan Januari s/d Pebruari 2014
Tahun Anggaran 2014

Belanja ATK Belanja Barang/ Jasa

No Puskesmas
Januari Pebruari Jumlah Januari Pebruari Jumlah

1 Banyumudal 642,500 1,354,500 1,997,000 2,847,550 5,893,650 8,741,200

2 Warungrpring 506,000 463,500 969,500 1,991,500 1,823,250 3,814,750
3 Watukumpul 1,394,500 929,000 2,323,500 5,781,500 3,941,500 9,723,000
4 Pulosari 701,000 1,214,500 1,915,500 2,709,850 4,657,250 7,367,100
5 Belik 777,000 2,082,000 2,859,000 3,570,750 9,202,050 12,772,800
6 Bantarbolang 1,699,000 862,500 2,561,500 6,658,700 3,631,650 10,290,350
7 Randudongkal 1,927,500 3,294,000 5,221,500 15,100,800 25,553,625 40,654,425
8 Kalimas 713,000 1,058,500 1,771,500 2,257,800 5,060,500 7,318,300
9 Paduraksa 934,000 1,759,500 2,693,500 3,794,000 6,560,300 10,354,300
10 Mulyoharjo 1,983,000 1,514,500 3,497,500 8,504,100 5,528,450 14,032,550
11 Kebondalem 1,970,500 1,336,000 3,306,500 7,936,850 3,706,150 11,643,000
12 Banjardawa 1,180,000 752,000 1,932,000 4,083,150 2,813,150 6,896,300
13 Kabunan 1,164,500 647,500 1,812,000 4,493,150 4,659,200 9,152,350
14 Jebed 511,000 1,222,000 1,733,000 1,969,400 16,590,300 18,559,700
15 Petarukan 1,502,000 4,086,000 5,588,000 6,227,200 3,745,900 9,973,100
16 Klareyan 1,986,000 795,500 2,781,500 7,916,850 7,443,250 15,360,100
17 Losari 816,000 1,943,000 2,759,000 3,141,400 2,049,750 5,191,150
18 Kebandaran 372,000 570,000 942,000 1,395,150 21,550,000 22,945,150
19 Purwoharjo 4,533,000 4,142,000 8,675,000 22,942,650 4,232,200 27,174,850
20 Sarwodadi 539,000 981,500 1,520,500 2,015,500 2,997,050 5,012,550
21 Rowosari 949,500 667,500 1,617,000 3,559,500 2,998,050 6,557,550
22 Mojo 842000 1,683,500 2,525,500 3,194,800 6,549,400 9,744,200

JUMLAH 6,863,500 88,943,500 61,002,000 122,092,150 151,186,625 273,278,775

 Jumlah

Rp 10,738,200
Rp 4,784,250
Rp 12,046,500
Rp 9,282,600
Rp 15,631,800
Rp 12,851,850
Rp 45,875,925
Rp 9,089,800
Rp 13,047,800
Rp 17,530,050
Rp 14,949,500
Rp 8,828,300 1
Rp 10,964,350
Rp 20,292,700
Rp 15,561,100
Rp 18,141,600
Rp 7,950,150
Rp 23,887,150
Rp 35,849,850
Rp 6,533,050
Rp 8,174,550
Rp 12,269,700

Rp 470,093,625
Rekapitulasi : Pengembalian Income dan Kapitasi Askes Ke Puskesmas se Kabupaten Pemalang
Belanja Alat Tulis Kantor dan Belanja Barang/ Jasa
Bulan Maret 2014
Tahun Anggaran 2014

Belanja ATK Belanja Barang/ Jasa

No Puskesmas INCOME INCOME Jumlah Jumlah

Mar Jumlah Desember Jumlah

1 Banyumudal 3,408,000 3,408,000 13,578,000 13,994,100 Rp 10,222,800
2 Warungrpring 1,978,500 1,978,500 7,121,250 7,280,850 Rp 14,837,850
3 Watukumpul 2,752,500 2,752,500 11,796,075 12,127,875 Rp 14,137,400
4 Pulosari 2,105,000 2,105,000 7,825,450 8,122,750 Rp 42,495,150
5 Belik 4,541,000 4,541,000 18,502,600 18,900,700 Rp 23,441,700
6 Bantarbolang 6,003,500 6,003,500 23,974,300 24,377,200 Rp 30,380,700
7 Randudongkal 4,605,000 4,605,000 29,606,100 30,552,750 Rp 35,157,750
8 Kalimas 713,000 713,000 3,410,400 3,410,400 Rp 4,123,400
9 Paduraksa 2,478,500 2,478,500 9,719,650 10,581,250 Rp 13,059,750
10 Mulyoharjo 1,956,500 1,956,500 8,398,150 10,025,050 Rp 11,981,550
11 Kebondalem 2,964,500 2,964,500 12,020,350 13,240,750 Rp 16,025,250
12 Banjardawa 1,833,500 1,833,500 7,456,300 8,389,300 Rp 10,222,800
13 Kabunan 3,070,000 3,070,000 11,365,850 11,767,850 Rp 14,837,850
14 Jebed 3,791,500 3,791,500 14,127,050 14,476,250 Rp 18,267,750
15 Petarukan 8,554,000 8,554,000 32,898,950 33,941,150 Rp 42,495,150
16 Klareyan 11,116,000 11,116,000 43,281,950 43,619,750 Rp 54,735,750
17 Losari 3,780,000 3,780,000 14,249,700 15,012,300 Rp 18,792,300
18 Kebandaran 2,283,000 2,283,000 9,620,700 10,008,900 Rp 12,291,900
19 Purwoharjo 11,106,500 11,106,500 52,614,650 53,901,500 Rp 65,010,000
20 Sarwodadi 2,131,500 2,131,500 8,130,300 8,370,600 Rp 10,502,100
21 Rowosari 1,560,500 1,560,500 5,774,050 5,774,050 Rp 7,334,550
22 Mojo 2,797,000 2,797,000 10,458,650 10,681,850 Rp 134,780,850

JUMLAH 88,943,500 88,943,500 368,296,625 381,150,125 Rp 470,093,625

12903350
 Rekapitulasi Pengembalian Dana Non Kapitasi (Persalinan dan Rawat Inap)
Dukungan Operasional
Tahun Anggaran 2015

Dukungan Operasional (15%) dari Dana Non Kapitasi

No Puskesmas
Kesatu Th2014 Kedua Th 2014 Jumlah

1 Banyumudal 538,500 1,316,250 1,854,750

2 Warungrpring - 3,872,250 3,872,250
3 Watukumpul - 1,063,500 1,063,500
4 Pulosari 2,413,500 1,008,750 3,422,250
5 Belik 8,667,000 3,108,750 11,775,750
6 Bantarbolang 900,000 1,878,750 2,778,750
7 Randudongkal 30,266,250 5,627,250 35,893,500
8 Kalimas - 378,750 378,750
9 Paduraksa 6,323,250 1,425,000 7,748,250
10 Mulyoharjo 7,731,750 2,688,750 10,420,500
11 Kebondalem 3,390,750 5,398,500 8,789,250
12 Banjardawa 1,078,500 1,155,000 2,233,500
13 Kabunan 1,290,000 - 1,290,000
14 Jebed 990,000 4,783,500 5,773,500
15 Petarukan 22,783,500 7,429,500 30,213,000
16 Klareyan 1,209,750 453,750 1,663,500
17 Losari - 1,708,500 1,708,500
18 Kebandaran - 5,593,500 5,593,500
19 Purwoharjo 14,697,000 4,635,000 19,332,000
20 Sarwodadi 540,000 3,420,000 3,960,000
21 Rowosari 1,335,000 1,173,750 2,508,750
22 Mojo 4,857,000 990,000 5,847,000
0
JUMLAH 109,011,750 59,109,000 168,120,750
1
 Rekapitulasi Pengembalian INCOME Puskesmas
Belanja Barang dan Jasa
Tahun Anggaran 2015

INCOME
No Puskesmas
Nop 2014 Des 2014 Januari 2015

1 Banyumudal 4,080,000 4,437,450 4,431,300

2 Warungrpring 3,296,400 2,998,350 2,530,650
3 Watukumpul 5,206,650 5,904,975 5,211,825
4 Pulosari 2,990,850 3,955,800 3,986,250
5 Belik 3,680,850 5,732,850 5,309,550
6 Bantarbolang 3,625,875 4,663,350 4,050,225
7 Randudongkal 16,638,300 16,923,900 17,558,850
8 Kalimas 2,852,100 3,020,050 2,950,500
9 Paduraksa 4,880,400 4,709,250 5,795,250
10 Mulyoharjo 7,440,750 7,193,550 8,142,750
11 Kebondalem 6,576,750 6,547,500 6,583,275
12 Banjardawa 3,388,350 3,941,400 3,616,950
13 Kabunan 3,366,450 3,379,950 3,553,650
14 Jebed 2,611,650 2,784,450 3,029,250
15 Petarukan 9,592,950 9,556,950 9,328,500
16 Klareyan 4,237,800 4,481,550 3,831,450
17 Losari 4,422,600 4,582,350 4,591,200
18 Kebandaran 2,064,750 4,524,900 2,803,500
19 Purwoharjo 14,586,600 17,699,850 33,285,450
20 Sarwodadi 2,885,400 3,360,000 3,044,250
21 Rowosari 2,767,200 2,605,500 2,639,850
22 Mojo 5,331,300 5,668,650 5,095,800

JUMLAH 116,523,975 128,672,575 141,370,275

Jumlah

12,948,750
8,825,400
16,323,450
10,932,900
14,723,250
12,339,450
51,121,050
8,822,650
15,384,900
22,777,050
19,707,525
10,946,700 1
10,300,050
8,425,350
28,478,400
12,550,800
13,596,150
9,393,150
65,571,900
9,289,650
8,012,550
16,095,750

386,566,825
 Rekapitulasi Pengembalian Dana Non Kapitasi
Honoarium Jasa Pelayanan
Bulan Januari 1 (Desember 2016)

INCOME
No Puskesmas
Honor Jasa Pelayanan PPh 21 Jumlah
1 Banyumudal 5,736,000 5,392,950 6,170,300
2 Warungrpring 2,196,500 2,813,500 2,992,500
3 Watukumpul 6,012,250 6,992,225 6,696,575
4 Pulosari 3,123,500 6,652,310 4,369,750
5 Belik 15,585,550 6,575,850 7,416,050
6 Bantarbolang 4,736,000 5,452,100 4,050,225
7 Randudongkal 31,742,375 20,871,900 17,558,850
8 Kalimas 2,813,000 3,025,000 3,000,050
9 Paduraksa 4,394,600 5,136,000 5,795,250
10 Mulyoharjo 10,758,800 7,193,550 8,142,750
11 Kebondalem 5,547,500 6,547,500 6,583,275
12 Banjardawa 3,941,400 7,123,000 3,616,950
13 Kabunan 2,379,950 3,379,950 3,553,650
14 Jebed 2,784,450 2,784,450 4,039,150
15 Petarukan 14,221,300 11,469,450 9,328,500
16 Klareyan 4,481,550 4,481,550 3,831,450
17 Losari 2,582,350 4,582,350 4,591,200
18 Kebandaran 4,524,900 5,991,900 2,803,500
19 Purwoharjo 27,699,850 27,699,850 33,285,450
20 Sarwodadi 3,360,000 3,360,000 3,044,250
21 Rowosari 52,040,500 2,605,500 2,647,350
22 Mojo 6,739,900 5,668,650 4,953,800
23 DKK 44,871,313 44,668,553 80,539,876

JUMLAH 262,273,538 200,468,088 229,010,701

Jumlah
17,299,250
8,002,500
19,701,050
14,145,560
29,577,450
14,238,325
70,173,125
8,838,050
15,325,850
26,095,100
18,678,275
14,681,350
9,313,550
9,608,050
35,019,250
12,794,550
11,755,900
13,320,300
88,685,150
9,764,250
57,293,350
17,362,350
170,079,742

691,752,327
 REKAP PER KODE REKENING PENGEMBALIAN INCOME TAHUN ANGGARAN 2015
UNTUK PUSKESMAS DAN DKK
BAGIAN PEMBUKUAN BULAN NOPEMBER 2014

No Puskesmas Honor Jasa Pelayanan Belanja Barang/ Jasa

1 Banyumudal 5,736,000 4,080,000

2 Warungrpring 2,196,500 3,296,400
3 Watukumpul 6,012,250 5,206,650
4 Pulosari 3,123,500 2,990,850
5 Belik 15,585,550 3,680,850
6 Bantarbolang 4,736,000 3,625,875
7 Randudongkal 31,742,375 16,638,300
8 Kalimas 2,813,000 2,852,100
9 Paduraksa 4,394,600 4,880,400
10 Mulyoharjo 10,758,800 7,440,750
11 Kebondalem 5,547,500 6,576,750
12 Banjardawa 3,941,400 3,388,350
13 Kabunan 2,379,950 3,366,450
14 Jebed 2,784,450 2,611,650
15 Petarukan 14,221,300 9,592,950
16 Klareyan 4,481,550 4,237,800
17 Losari 2,582,350 4,422,600
18 Kebandaran 4,524,900 2,064,750
19 Purwoharjo 27,699,850 14,586,600
20 Sarwodadi 3,360,000 2,885,400
21 Rowosari 52,040,500 2,767,200
22 Mojo 6,739,900 5,331,300
23 DKK 44,871,313 28,145,300

JUMLAH 262,273,538 144,669,275

Pemalang, 12 Januari 2015

Kepala Dinas Kesehatan
Kabupaten Pemalang
 Dr. Humartono
NIP. 19571231 198511 1 004
AP PER KODE REKENING PENGEMBALIAN INCOME TAHUN ANGGARAN 2015
UNTUK PUSKESMAS DAN DKK
BAGIAN PEMBUKUAN BULAN NOPEMBER 2014

Jumlah

9,816,000
5,492,900
11,218,900
6,114,350
19,266,400
8,361,875
48,380,675
5,665,100
9,275,000
18,199,550
12,124,250
7,329,750
5,746,400
5,396,100
23,814,250
8,719,350
7,004,950
6,589,650
42,286,450
6,245,400
54,807,700
12,071,200
73,016,613

406,942,813
 REKAP PER KODE REKENING PENGEMBALIAN INCOME TAHUN ANGGARAN 2015
UNTUK PUSKESMAS DAN DKK
BAGIAN PEMBUKUAN BULAN DESEMBER 2014

No Puskesmas Honor Jasa Pelayanan Belanja Barang/ Jasa

1 Banyumudal 4,437,450 5,392,950

2 Warungrpring 2,998,350 2,813,500
3 Watukumpul 5,904,975 6,992,225
4 Pulosari 3,955,800 6,652,310
5 Belik 5,732,850 6,575,850
6 Bantarbolang 4,663,350 5,452,100
7 Randudongkal 16,923,900 20,871,900
8 Kalimas 3,020,050 3,025,000
9 Paduraksa 4,709,250 5,136,000
10 Mulyoharjo 7,193,550 7,193,550
11 Kebondalem 6,547,500 6,547,500
12 Banjardawa 3,941,400 7,123,000
13 Kabunan 3,379,950 3,379,950
14 Jebed 2,784,450 2,784,450
15 Petarukan 9,556,950 11,469,450
16 Klareyan 4,481,550 4,481,550
17 Losari 4,582,350 4,582,350
18 Kebandaran 4,524,900 5,991,900
19 Purwoharjo 17,699,850 27,699,850
20 Sarwodadi 3,360,000 3,360,000
21 Rowosari 2,605,500 2,605,500
22 Mojo 5,668,650 5,668,650
23 DKK 44,871,313 25,442,100

JUMLAH 173,543,888 181,241,635

Pemalang, 28 Januari 2015

Kepala Dinas Kesehatan
Kabupaten Pemalang
 Dr. Humartono
NIP. 19571231 198511 1 004
GEMBALIAN INCOME TAHUN ANGGARAN 2015
USKESMAS DAN DKK
UAN BULAN DESEMBER 2014

Jumlah

9,830,400
5,811,850
12,897,200
10,608,110
12,308,700
10,115,450
37,795,800
6,045,050
9,845,250
14,387,100
13,095,000
11,064,400
6,759,900
5,568,900 0
21,026,400
8,963,100
9,164,700
10,516,800
45,399,700
6,720,000
5,211,000
11,337,300
70,313,413

354,785,523
 REKAP PER KODE REKENING PENGEMBALIAN INCOME TAHUN ANGGARAN 2015
UNTUK PUSKESMAS DAN DKK
BAGIAN PEMBUKUAN BULAN JANUARI 2015

No Puskesmas Honor Jasa Pelayanan Belanja Barang/ Jasa

1 Banyumudal 4,431,300 6,170,300

2 Warungrpring 2,530,650 2,992,500
3 Watukumpul 5,211,825 6,696,575
4 Pulosari 3,986,250 4,369,750
5 Belik 5,309,550 7,416,050
6 Bantarbolang 4,050,225 4,050,225
7 Randudongkal 17,558,850 17,558,850
8 Kalimas 2,950,500 3,000,050
9 Paduraksa 5,795,250 5,795,250
10 Mulyoharjo 8,142,750 8,142,750
11 Kebondalem 6,583,275 6,583,275
12 Banjardawa 3,616,950 3,616,950
13 Kabunan 3,553,650 3,553,650
14 Jebed 3,029,250 4,039,150
15 Petarukan 9,328,500 9,328,500
16 Klareyan 3,831,450 3,831,450
17 Losari 4,591,200 4,591,200
18 Kebandaran 2,803,500 2,803,500
19 Purwoharjo 33,285,450 33,285,450
20 Sarwodadi 3,044,250 3,044,250
21 Rowosari 2,639,850 2,647,350
22 Mojo 5,095,800 4,953,800
23 DKK 44,871,313 26,513,200

JUMLAH 186,241,588 174,984,025

Pemalang, 12 Pebruari 2015

Kepala Dinas Kesehatan
Kabupaten Pemalang
 Dr. Humartono
NIP. 19571231 198511 1 004
AP PER KODE REKENING PENGEMBALIAN INCOME TAHUN ANGGARAN 2015
UNTUK PUSKESMAS DAN DKK
BAGIAN PEMBUKUAN BULAN JANUARI 2015

Jumlah

10,601,600
5,523,150
11,908,400
8,356,000
12,725,600
8,100,450
35,117,700
5,950,550
11,590,500
16,285,500
13,166,550
7,233,900
7,107,300
7,068,400
18,657,000
7,662,900
9,182,400
5,607,000
66,570,900
6,088,500
5,287,200
10,049,600
71,384,513

361,225,613
 Rekapitulasi Pengembalian INCOME Puskesmas
Honor Jasa Pelayanan
BAGIAN : JUNI 2015

No Puskesmas Honor Jasa Pelayanan PPH Pasal 21

1 Banyumudal 4,431,300 209,595

2 Warungrpring 3,425,611 217,418
3 Watukumpul 5,211,825 228,500
4 Pulosari 3,986,250 320,300
5 Belik 5,309,550 198,700
6 Bantarbolang 4,050,225 225,600
7 Randudongkal 17,558,850 658,478
8 Kalimas 3,332,500 162,200
9 Paduraksa 5,795,250 245,300
10 Mulyoharjo 8,142,750 425,600
11 Kebondalem 6,583,275 375,200
12 Banjardawa 3,616,950 185,300
13 Kabunan 3,553,650 243,511
14 Jebed 3,029,250 152,300
15 Petarukan 9,328,500 475,600
16 Klareyan 3,831,450 321,200
17 Losari 4,591,200 238,215
18 Kebandaran 2,803,500 180,300
19 Purwoharjo 33,285,450 4,286,591
20 Sarwodadi 3,044,250 125,666
21 Rowosari 2,639,850 90,125
22 Mojo 5,095,800 156,298
23 DKK 44,871,313 5,088,800

JUMLAH 187,518,549 14,810,797

Rekapitulasi Pengembalian INCOME Puskesmas
Honor Jasa Pelayanan
BAGIAN : JUNI 2015

Jumlah

4,221,705
3,208,193
4,983,325
3,665,950
5,110,850
3,824,625
16,900,372
3,170,300
5,549,950
7,717,150
6,208,075
3,431,650
3,310,139
2,876,950
8,852,900
3,510,250
4,352,985
2,623,200
28,998,859
2,918,584
2,549,725
4,939,502
39,782,513

172,707,752
 Rekapitulasi Pengembalian INCOME Puskesmas
Honor Jasa Pelayanan
BAGIAN : JULI 2015

No Puskesmas Honor Jasa Pelayanan PPH Pasal 21

1 Banyumudal 6,473,950 449,595

2 Warungrpring 5,686,250 257,548
3 Watukumpul 8,510,800 492,500
4 Pulosari 4,680,750 288,500
5 Belik 5,724,150 363,387
6 Bantarbolang 6,356,450 349,445
7 Randudongkal 17,032,150 858,468
8 Kalimas 4,254,050 243,978
9 Paduraksa 6,675,250 410,855
10 Mulyoharjo 8,796,550 493,080
11 Kebondalem 6,644,850 447,143
12 Banjardawa 6,335,750 375,802
13 Kabunan 4,301,000 171,750
14 Jebed 3,397,150 243,488
15 Petarukan 11,106,500 501,723
16 Klareyan 6,072,600 213,570
17 Losari 6,715,850 253,767
18 Kebandaran 4,884,200 288,871
19 Purwoharjo 21,493,350 1,286,611
20 Sarwodadi 4,300,300 167,396
21 Rowosari 2,995,350 94,975
22 Mojo 5,802,750 186,268
23 DKK 42,346,250 5,068,846

JUMLAH 200,586,250 13,507,566

Rekapitulasi Pengembalian INCOME Puskesmas
Honor Jasa Pelayanan
BAGIAN : JULI 2015

Jumlah

6,024,355
5,428,702
8,018,300
4,392,250
5,360,763
6,007,005
16,173,682
4,010,072
6,264,395
8,303,470
6,197,707
5,959,948
4,129,250
3,153,662
10,604,777
5,859,030
6,462,083
4,595,329
20,206,739
4,132,904
2,900,375
5,616,482
37,277,404

187,078,684
 Rekapitulasi Pengembalian INCOME Puskesmas
Belanaja Barang dan Jasa
BAGIAN : Agustus 2015

No Puskesmas Belanja Barang dan Jasa

1 Banyumudal 4,482,300
2 Warungrpring 3,309,300
3 Watukumpul 5,832,750
4 Pulosari 4,617,300
5 Belik 5,243,250
6 Bantarbolang 4,787,325
7 Randudongkal 10,950,450
8 Kalimas 3,730,800
9 Paduraksa 5,191,650
10 Mulyoharjo 7,814,850
11 Kebondalem 6,105,300
12 Banjardawa 4,104,150
13 Kabunan 3,525,900
14 Jebed 3,199,200
15 Petarukan 10,051,650
16 Klareyan 3,913,200
17 Losari 5,226,450
18 Kebandaran 3,600,600
19 Purwoharjo 18,482,950
20 Sarwodadi 3,409,350
21 Rowosari 2,847,225
22 Mojo 6,395,400
23 DKK 26,406,675

JUMLAH 153,228,025
Rekapitulasi Pengembalian INCOME Puskesmas
Belanaja Barang dan Jasa
BAGIAN : Agustus 2015

Jumlah

4,482,300
3,309,300
5,832,750
4,617,300
5,243,250
4,787,325
10,950,450
3,730,800
5,191,650
7,814,850
6,105,300
4,104,150
3,525,900
3,199,200
10,051,650
3,913,200
5,226,450
3,600,600
18,482,950
3,409,350
2,847,225
6,395,400
26,406,675

153,228,025
 Rekapitulasi Pengembalian INCOME Puskesmas
Honorarium Jasa Pelayanan
Bulan : NOPEMBER TH. 2015

Honorarium Jasa
No Puskesmas PPh Pasal 21
Pelayanan
1 Banyumudal 6,811,700 374,191
2 Warungrpring 4,012,600 191,600
3 Watukumpul 9,437,500 327,150
4 Pulosari 5,878,300 215,160
5 Belik 5,824,150 322,500
6 Bantarbolang 7,735,425 434,918
7 Randudongkal 20,460,300 776,632
8 Kalimas 3,538,271 233,171
9 Paduraksa 6,658,750 412,325
10 Mulyoharjo 12,506,150 741,698
11 Kebondalem 7,197,350 488,445
12 Banjardawa 6,677,200 412,460
13 Kabunan 4,806,750 189,750
14 Jebed 3,544,800 254,070
15 Petarukan 11,650,850 523,251
16 Klareyan 6,147,350 211,395
17 Losari 6,773,500 258,822
18 Kebandaran 4,736,650 183,725
19 Purwoharjo 21,597,750 1,309,229
20 Sarwodadi 4,539,875 174,895
21 Rowosari 3,359,875 113,388
22 Mojo 6,177,600 196,650
23 DKK 46,943,000 5,527,538
JUMLAH 217,015,696 13,872,963

Kepala Dinas Kesehatan

Kabupaten Pemalang
 dr. Erna Nuraini, Mhlth.Sc.
NIP. 19630329 198903 2 007
Rekapitulasi Pengembalian INCOME Puskesmas
Honorarium Jasa Pelayanan
Bulan : NOPEMBER TH. 2015

Jumlah

6,437,509
3,821,000
9,110,350
5,663,140
5,501,650
7,300,507
19,683,668
3,305,100
6,246,425
11,764,452
6,708,905
6,264,740
4,617,000
3,290,730
11,127,599
5,935,955
6,514,678
4,552,925
20,288,521
4,364,980
3,246,487
5,980,950
41,415,462
203,142,733

Kepala Dinas Kesehatan

Kabupaten Pemalang
 dr. Erna Nuraini, Mhlth.Sc.
NIP. 19630329 198903 2 007
 Rekapitulasi Pengembalian INCOME Puskesmas
Honorarium Jasa Pelayanan
Bulan : NOPEMBER 2015 DAN JANUARI 1

No Puskesmas NOPEMBER PPh Pasal 21 Jumlah DESEMBER

1 Banyumudal 6,811,700 374,191 6,437,509 6,169,550

2 Warungrpring 4,012,600 191,600 3,821,000 3,282,600
3 Watukumpul 9,437,500 327,150 9,110,350 9,181,950
4 Pulosari 5,878,300 215,160 5,663,140 5,488,450
5 Belik 5,824,150 322,500 5,501,650 6,342,750
6 Bantarbolang 7,735,425 434,918 7,300,507 6,894,800
7 Randudongkal 20,460,300 776,632 19,683,668 18,361,700
8 Kalimas 3,538,271 233,171 3,305,100 3,421,350
9 Paduraksa 6,658,750 412,325 6,246,425 7,134,350
10 Mulyoharjo 12,506,150 741,698 11,764,452 10,613,188
11 Kebondalem 7,197,350 488,445 6,708,905 6,781,600
12 Banjardawa 6,677,200 412,460 6,264,740 4,632,900
13 Kabunan 4,806,750 189,750 4,617,000 4,230,650
14 Jebed 3,544,800 254,070 3,290,730 2,904,550
15 Petarukan 11,650,850 523,251 11,127,599 11,887,700
16 Klareyan 6,147,350 211,395 5,935,955 5,663,750
17 Losari 6,773,500 258,822 6,514,678 4,986,000
18 Kebandaran 4,736,650 183,725 4,552,925 4,282,750
19 Purwoharjo 21,597,750 1,309,229 20,288,521 31,788,300
20 Sarwodadi 4,539,875 174,895 4,364,980 3,795,300
21 Rowosari 3,359,875 113,388 3,246,487 2,505,300
22 Mojo 6,177,600 196,650 5,980,950 4,781,100
23 DKK 46,943,000 5,527,538 41,415,462 52,434,113
JUMLAH 217,015,696 13,872,963 203,142,733 217,564,701
kesmas

ARI 1

PPh Pasal 21 Jumlah TOTAL

393,105 5,776,445 12,213,954

141,903 3,140,697 6,961,697
317,950 8,864,000 17,974,350
272,630 5,215,820 10,878,960
337,689 6,005,061 11,506,711
391,130 6,503,670 13,804,177
700,805 17,660,895 37,344,563
221,305 3,200,045 6,505,145
440,335 6,694,015 12,940,440
627,533 9,985,655 21,750,107
460,755 6,320,845 13,029,750
353,373 4,279,527 10,544,267
183,373 4,047,277 8,664,277
208,181 2,696,369 5,987,099
554,612 11,333,088 22,460,687
192,625 5,471,125 11,407,080
199,497 4,786,503 11,301,181
172,600 4,110,150 8,663,075
1,752,040 30,036,260 50,324,781
16,764 3,778,536 8,143,516
85,110 2,420,190 5,666,677
152,746 4,628,354 10,609,304
5,986,228 46,447,885 87,863,347
14,162,289 203,402,412 406,545,145

Kepala Dinas Kesehatan

Kabupaten Pemalang
dr. Erna Nuraini, Mhlth.Sc.
NIP. 19630329 198903 2 007
 Rekapitulasi Pengembalian INCOME Puskesmas
Honorarium Jasa Pelayanan
Bulan : JSEPTEMBER DAN OKTOBER TH. 2016

No Puskesmas SEPTEMBER PPh Pasal 21 Jumlah PEBRUARI

1 Banyumudal 54 351,920 -351,866 5,684,900

2 Warungrpring 4,055,125 166,260 3,888,865 4,988,050
3 Watukumpul 11,791,900 421,250 11,370,650 9,546,150
4 Pulosari 6,701,725 306,410 6,395,315 5,961,300
5 Belik 6,865,850 352,155 6,513,695 6,599,700
6 Bantarbolang 6,691,100 375,010 6,316,090 6,351,500
7 Randudongkal 20,781,350 628,338 20,153,012 24,377,300
8 Kalimas 3,508,271 208,171 3,300,100 4,351,250
9 Paduraksa 6,611,250 413,175 6,198,075 6,154,450
10 Mulyoharjo 12,959,200 763,785 12,195,415 10,765,200
11 Kebondalem 7,029,800 478,818 6,550,982 7,487,200
12 Banjardawa 6,023,800 378,264 5,645,536 6,284,600
13 Kabunan 4,163,350 178,000 3,985,350 4,189,950
14 Jebed 2,791,100 200,050 2,591,050 3,095,600
15 Petarukan 10,503,650 497,969 10,005,681 11,738,750
16 Klareyan 6,351,750 213,575 6,138,175 6,012,300
17 Losari 5,722,250 236,582 5,485,668 6,401,550
18 Kebandaran 5,077,600 206,323 4,871,277 6,368,200
19 Purwoharjo 33,387,650 1,813,651 31,573,999 30,654,800
20 Sarwodadi 4,281,100 163,856 4,117,244 4,675,200
21 Rowosari 3,218,450 109,565 3,108,885 3,307,850
22 Mojo 5,749,800 176,112 5,573,688 6,291,000
23 DKK 56,102,700 6,432,759 49,669,941 58,741,800
JUMLAH 230,368,825 15,071,998 215,296,827 240,028,600
kesmas

H. 2016

PPh Pasal 21 Jumlah TOTAL

396,690 5,288,210 4,936,344

210,798 4,777,252 8,666,117
340,800 9,205,350 20,576,000
357,907 5,603,393 11,998,708
363,849 6,235,851 12,749,546
370,450 5,981,050 12,297,140
939,693 23,437,607 43,590,619
304,200 4,047,050 7,347,150
510,416 5,644,034 11,842,109
397,616 10,367,584 22,562,999
179,400 7,307,800 13,858,782
196,429 6,088,171 11,733,707
415,200 3,774,750 7,760,100
202,460 2,893,140 5,484,190
415,200 11,323,550 21,329,231
257,082 5,755,218 11,893,393
255,543 6,146,007 11,631,675
255,543 6,112,657 10,983,934
1,781,314 28,873,486 60,447,485
185,918 4,489,282 8,606,526
112,695 3,195,155 6,304,040
186,736 6,104,264 11,677,952
6,725,936 52,015,864 101,685,805
15,361,875 224,666,725 439,963,552

Kepala Dinas Kesehatan

Kabupaten Pemalang
dr. Erna Nuraini, Mhlth.Sc.
NIP. 19630329 198903 2 007
 Rekapitulasi Pengembalian INCOME Puskesmas
Honorarium Jasa Pelayanan
Bulan : SEPTEMBER DAN OKTOBER TH. 2016

No Puskesmas SEPTEMBER PPh Pasal 21 Jumlah OKTOBER

1 Banyumudal 6,521,550 456,509 6,065,042 5,429,000

2 Warungrpring 5,090,600 356,342 4,734,258 5,284,850
3 Watukumpul 9,415,400 659,078 8,756,322 8,739,750
4 Pulosari 7,201,000 504,070 6,696,930 6,620,150
5 Belik 10,006,550 700,459 9,306,092 7,149,950
6 Bantarbolang 7,377,800 516,446 6,861,354 9,380,100
7 Randudongkal 19,395,350 1,357,675 18,037,676 22,550,550
8 Kalimas 4,805,550 336,389 4,469,162 4,011,000
9 Paduraksa 6,885,600 481,992 6,403,608 7,435,000
10 Mulyoharjo 9,427,275 659,909 8,767,366 12,404,400
11 Kebondalem 8,126,400 568,848 7,557,552 9,665,850
12 Banjardawa 6,168,450 431,792 5,736,659 6,651,050
13 Kabunan 4,325,600 302,792 4,022,808 4,692,500
14 Jebed 3,015,800 211,106 2,804,694 3,970,800
15 Petarukan 11,604,700 812,329 10,792,371 13,527,050
16 Klareyan 5,948,150 416,371 5,531,780 7,144,800
17 Losari 6,988,100 489,167 6,498,933 5,207,050
18 Kebandaran 5,983,100 418,817 5,564,283 7,093,600
19 Purwoharjo 25,101,950 1,757,137 23,344,814 27,931,050
20 Sarwodadi 5,164,800 361,536 4,803,264 5,798,850
21 Rowosari 3,307,900 231,553 3,076,347 3,532,950
22 Mojo 4,924,950 344,747 4,580,204 5,692,300
23 DKK 55,634,325 3,894,403 51,739,922 60,148,200
JUMLAH 232,420,900 16,269,463 216,151,437 250,060,800
kesmas

H. 2016

PPh Pasal 21 Jumlah TOTAL

380,030 5,048,970 11,114,012

369,940 4,914,911 9,649,169
611,783 8,127,968 16,884,290
463,411 6,156,740 12,853,670
500,497 6,649,454 15,955,545
656,607 8,723,493 15,584,847
1,578,539 20,972,012 39,009,687
280,770 3,730,230 8,199,392
520,450 6,914,550 13,318,158
868,308 11,536,092 20,303,458
676,610 8,989,241 16,546,793
465,574 6,185,477 11,922,135
328,475 4,364,025 8,386,833
277,956 3,692,844 6,497,538
946,894 12,580,157 23,372,528
500,136 6,644,664 12,176,444
364,494 4,842,557 11,341,490
496,552 6,597,048 12,161,331
1,955,174 25,975,877 49,320,690
405,920 5,392,931 10,196,195
247,307 3,285,644 6,361,991
398,461 5,293,839 9,874,043
4,210,374 55,937,826 107,677,748
17,504,256 232,556,544 448,707,981

Kepala Dinas Kesehatan

Kabupaten Pemalang
dr. Erna Nuraini, Mhlth.Sc.
NIP. 19630329 198903 2 007
 Rekapitulasi Pengembalian Dana Non Kapitasi
Honoarium Jasa Pelayanan
Bulan Januari 1 (Desember 2016)

No Puskesmas Honor Jasa Pelayanan PPh 21

1 Banyumudal _ _
2 Warungrpring _ _
3 Watukumpul Rp 5,850,000 200,900
4 Pulosari _ _
5 Belik Rp 13,236,925 539,662
6 Bantarbolang Rp 13,068,250 437,285
7 Randudongkal Rp 44,729,750 1,905,754
8 Kalimas Rp 5,014,750 126,746
9 Paduraksa Rp 13,835,250 883,328
10 Mulyoharjo Rp 325,000 14,050
11 Kebondalem _ _
12 Banjardawa Rp 461,500 24,179
13 Kabunan _ _
14 Jebed Rp 10,920,000 437,500
15 Petarukan _ _
16 Klareyan Rp 4,135,203 78,614
17 Losari Rp 19,729,255 303,527
18 Kebandaran Rp 21,166,200 358,204
19 Purwoharjo Rp 15,678,000 761,388
20 Sarwodadi Rp 650,000 7,500
21 Rowosari Rp 601,250 9,251
22 Mojo Rp 2,939,723 48,457
23 DKK Rp 53,028,140 6,373,319

JUMLAH 225,369,196 12,509,664

Kepala Dinas Kesehatan

 Kabupaten Pemalang

dr. Erna Nuraini, Mhlth.Sc.

NIP. 19630329 198903 2 007
Rekapitulasi Pengembalian Dana Non Kapitasi
Honoarium Jasa Pelayanan
Bulan Januari 1 (Desember 2016)

Jumlah
_
_
5,649,100
_
12,697,263
12,630,965
42,823,996
4,888,004
12,951,922
310,950
_
437,321
_
10,482,500
_
4,056,589
19,425,728
20,807,996
14,916,612
642,500
591,999
2,891,266
46,654,821

212,859,532

Kepala Dinas Kesehatan

 Kabupaten Pemalang

dr. Erna Nuraini, Mhlth.Sc.

NIP. 19630329 198903 2 007
 Rekapitulasi Pengembalian INCOME Puskesmas
Honorarium Jasa Pelayanan
Bulan : NOPEMBER DAN JANUARI 1

No Puskesmas NOPEMBER PPh Pasal 21 Jumlah JANUARI 1

1 Banyumudal 4,987,400 398,992 4,588,408 7,945,400

2 Warungrpring 5,043,650 403,492 4,640,158 5,397,400
3 Watukumpul 9,875,275 790,022 9,085,253 10,025,275
4 Pulosari 4,634,300 370,744 4,263,556 8,486,850
5 Belik 5,694,700 455,576 5,239,124 9,939,250
6 Bantarbolang 7,900,000 632,000 7,268,000 7,929,500
7 Randudongkal 20,169,800 1,613,584 18,556,216 17,994,500
8 Kalimas 3,446,550 275,724 3,170,826 8,144,850
9 Paduraksa 6,970,750 557,660 6,413,090 7,208,500
10 Mulyoharjo 11,294,050 903,524 10,390,526 12,012,525
11 Kebondalem 9,353,650 748,292 8,605,358 9,308,200
12 Banjardawa 6,073,950 485,916 5,588,034 6,624,050
13 Kabunan 5,299,700 423,976 4,875,724 4,707,750
14 Jebed 4,075,650 326,052 3,749,598 3,437,950
15 Petarukan 14,270,350 1,141,628 13,128,722 10,333,700
16 Klareyan 6,546,250 523,700 6,022,550 6,246,300
17 Losari 6,591,800 527,344 6,064,456 5,101,400
18 Kebandaran 5,262,050 420,964 4,841,086 5,025,400
19 Purwoharjo 31,104,300 2,488,344 28,615,956 26,753,250
20 Sarwodadi 5,534,850 442,788 5,092,062 5,359,750
21 Rowosari 3,455,400 276,432 3,178,968 3,339,750
22 Mojo 5,115,300 409,224 4,706,076 4,990,950
23 DKK _ _ _ 58,686,600
JUMLAH 182,699,725 14,615,978 168,083,747 244,999,100
kesmas

PPh Pasal 21 Jumlah TOTAL

635,632 7,309,768 11,898,176

431,792 4,965,608 9,605,766
802,022 9,223,253 18,308,506
678,948 7,807,902 12,071,458
795,140 9,144,110 14,383,234
634,360 7,295,140 14,563,140
1,439,560 16,554,940 35,111,156
651,588 7,493,262 10,664,088
576,680 6,631,820 13,044,910
961,002 11,051,523 21,442,049
744,656 8,563,544 17,168,902
529,924 6,094,126 11,682,160
376,620 4,331,130 9,206,854
275,036 3,162,914 6,912,512
826,696 9,507,004 22,635,726
499,704 5,746,596 11,769,146
408,112 4,693,288 10,757,744
402,032 4,623,368 9,464,454
2,140,260 24,612,990 53,228,946
428,780 4,930,970 10,023,032
267,180 3,072,570 6,251,538
399,276 4,591,674 9,297,750
4,694,928 53,991,672 53,991,672
19,599,928 225,399,172 393,482,919

Kepala Dinas Kesehatan

Kabupaten Pemalang
dr. Erna Nuraini, Mhlth.Sc.
NIP. 19630329 198903 2 007