Pajak Blud

SKOR INDIVIDU REMUNERAS
DATA KARYAWAN PER UNIT KERJA

PANGKAT / GAJI POKOK
NO NAMA LENGKAP/ NIP
GOL JUMLAH N MK B S
BASIC INDEX (1)
1 2 3 4
DIREKSI RSUD KAB. GRESIK

1 dr. ENDANG PUSPITOWATI, Sp THT-KL Gol. IV/ c Rp 4,862,300 48 5 1 53
2 dr. HARITA KHASUN, M.Kes Gol. IV/ b Rp 4,665,000 46 3 1 49
3 MAFTUKHAN,S.Kep.Ners (CUTI HAJI) Gol. IV/ a Rp 3,953,600 39 5 1 44
1 BAGIAN TATA USAHA

1 TEGUH IMAN SUBAGJO, SE, Msi Gol. IV/ a Rp 3,953,600 39 3 1 42
2 SRINI HENY, SH Gol. III/ d Rp 4,429,300 44 3 1 47
3 HARIANTO, S.Kep Ners Gol. III/ d Rp 3,912,600 39 5 1 44
4 ZAINUL ARIFIN, SE Gol. III/ c Rp 3,753,800 37 2 1 39
5 AINUR ROFIK, SE Gol. III/ d Rp 4,035,800 40 5 1 45
6 EKO YOELIANTO, SE Gol. III/ c Rp 3,315,900 33 5 1 38
7 SITI MAGHFIROTUN NI'MAH,SKM Gol. III/ b Rp 2,810,200 28 4 1 32
8 ABD. DJADI, SE Gol. III/ a Rp 3,148,300 31 5 1 36
9 ERRI TRI SUSILO Gol. II/ c Rp 2,640,600 26 5 1 31
10 SRI WINARTI Gol. II/ c Rp 3,083,400 30 5 1 35
11 FAFAN SULISTIYONO Gol. II/ c Rp 2,640,600 26 5 1 31
12 SAIRIN Gol. II/ c Rp 3,180,500 31 5 1 36
13 PRAYOGI PURWO SANTOSO Gol. II/ c Rp 2,456,000 24 5 1 29
14 BASHORI Gol. II/ a Rp 2,284,400 22 5 1 27
15 WIWIN IDA FAIZAH, SE BLUD Rp. 1.829.652/2.456.700 24 5 1 29
16 ESTI HARDIANTI, STP BLUD Rp. 1.829.652/2.456.700 24 5 1 29
17 DIDIK ACHIRIYANTO, ST BLUD Rp. 1.829.652/2.456.700 24 5 1 29
18 KUSMIATI BLUD Rp. 1.505.340/1.926.000 19 5 1 24
19 RUSLI, SH BLUD Rp. 1.585.698/2.456.700 24 3 1 27
20 RULLY ADITYAWARMAN, SE BLUD Rp. 1.829.652/2.456.700 24 5 1 29
21 WISNU ADI, S.Kom BLUD Rp. 1.829.652/2.456.700 24 3 1 27
22 IMAM BASUKI BLUD Rp. 1.254.035/1.692100 16 3 1 19
23 SHOLIHATUL MAGHFIROH, SKM BLUD Rp. 1.341.745/2.456.700 24 2 1 26
24 RIKKI ARIYADI BLUD Rp. 1.003.560/1.926.000 19 2 1 21
25 M. ABDUL MUNDOFAR BLUD Rp. 1.003.560/1.926.000 19 2 1 21
26 SOFIYANTI, SE BLUD Rp. 1.219.768/2.456.700 24 2 1 26
MOHON KOREKSI DAN PARAF

Page 1 of 248
DIKEMBALIKAN KE BAGIAN PERSONALIA PALING LAMBAT TGL 30 SEPTEMBER 2017
GOL JUMLAH N MK B S
BASIC INDEX (1)
27 SRI SURATMIWATI, ST BLUD Rp. 1.829.652/2.456.700 24 5 1 29
28 FINA RAHMI MAULUDA, SE.I BLUD Rp. 1.219.768/2.456.700 24 1 1 25
II BAGIAN KEUANGAN
1 Dra. Ec.ANNA SRI ASIH A, M.Ak Gol. IV/ a Rp 4,078,100 40 3 1 43
2 JULIARNI,SE.,M.Aks Gol. IV/ a Rp 3,953,600 39 4 1 43
3 LISTI AJOENI,SE.,M.Kes Gol. IV/ a Rp 4,762,000 47 5 1 52
4 LATHIFAH HANIM Gol. III/ b Rp 3,601,400 36 5 1 41
5 DWI RETNO WIDYASTUTI, S.Sos, Msi Gol. III/ c Rp 3,753,800 37 5 1 42
6 UMU KHAMNAH,SE Gol. III/ b Rp 2,810,200 28 4 1 32
7 WAHYUNI, SE Gol. III/ b Rp 3,084,200 30 5 1 35
8 EKO BAMBANG WAHYU .C, SE Gol. III/ b Rp 3,084,200 30 5 1 35
9 SUMAWATI, A.Md Gol. III/ a Rp 2,959,000 29 5 1 34
10 MARIYA DAMAYANTI, A.Md Gol. II/ d Rp 2,586,700 25 4 1 29
11 PRIESDA DHITA MELINDA, A.Md Gol. II/ d Rp 2,752,300 27 5 1 32
12 ISTIN ROHMAH Gol. II/ c Rp 2,898,000 28 5 1 33
13 FAIZATUL MARFU'AH Gol. II/ c Rp 2,989,300 29 5 1 34
14 MURJIONO Gol. II/ c Rp 2,809,500 28 5 1 33
15 JUMAIYAH Gol. II/ c Rp 3,083,400 30 5 1 35
16 ROUDHATUL AZIZAH Gol. II/ c Rp 2,640,600 26 5 1 31
17 BUARI Gol. II/ c Rp 2,640,600 26 5 1 31
18 SHINTA ISTANTI Gol. II/ c Rp 2,640,600 26 5 1 31
19 M. IWAN SETIYAWAN Gol. II/ c Rp 2,559,900 25 5 1 30
20 INDAH SIH PRATININGTYAS, SE BLUD Rp. 1.829.652/2.456.700 24 5 1 29
21 DEDY TRI KURNIAWAN, SE BLUD Rp. 1.829.652/2.456.700 24 5 1 29
22 ACHMAD DJUNAIDI, S.Sos BLUD Rp. 1.829.652/2.456.700 24 5 1 29
23 FARIDA TRI P.N., A.Md BLUD Rp. 1.662.393/2.192.200 21 5 1 26
24 ABDUL WAHID SATRIO Gol. II/ c Rp 2,640,600 26 5 1 31
25 ANITA SULISTYOWATI, A.Md. BLUD Rp. 1.440.741/2.192.200 21 3 1 24
26 ARI SETYORINI, S.Sos BLUD Rp. 1.829.652/2.456.700 24 5 1 29
27 ASTUTI WAHYU UTAMI, S.Pd BLUD Rp. 1.341.745/2.456.700 24 2 1 26
28 TRISMA SULYGANISTIA, S.Pd (CUTI) BLUD Rp. 1.341.745/2.456.700 24 2 1 26
29 AAN TRIWAHYU D., SE BLUD Rp. 1.341.745/2.456.700 24 2 1 26
30 ARIFUDIN SUPRIYANTO, SE BLUD Rp. 1.829.652/2.456.700 24 3 1 27

Page 2 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
III BAGIAN RENGRAM

1 KUSNADI, SE, MM (Pensiun 1/8/2017) Gol. IV/ b Rp 4,811,900 48 3 1 51
2 AKHMAD MUNIF,S.Sos Gol. III/ d Rp 4,035,800 40 5 1 45
3 HELINA RUSFIDIATI, SKM Gol. III/ d Rp 4,162,900 41 5 1 46
4 SUDARMINI Gol. III/ b Rp 3,491,500 34 5 1 39
5 DWI HANDAYANI Gol. III/ a Rp 2,696,200 26 5 1 31
6 MUNTARI Gol. II/ d Rp 3,213,800 32 4 1 36
7 SUPRIATIN Gol. II/ c Rp 2,898,000 28 5 1 33
8 FARIDAH HANIM Gol. II/ c Rp 2,898,000 28 5 1 33
9 TITI YUNITA, A.Md Gol. III/ a Rp 3,052,200 30 5 1 35
10 NUR FITRIANA Gol. II/ c Rp 2,723,700 27 5 1 32
11 MUSRIFAH Gol. II/ c Rp 2,723,700 27 5 1 32
12 DWI RESMIADI Gol. II/ c Rp 2,640,600 26 5 1 31
13 UMIK NINGSIH Gol. II/ c Rp 2,640,600 26 4 1 30
14 AGUS SLAMET Gol. II/ a Rp 2,214,700 22 5 1 27
15 RAGIL MUSTIKASARI,AMd.PK (Keluar 1 Me Gol. II/ d Rp 2,507,800 25 3 1 28
16 QORI'NURLAILY, AMd PK (CUTI) Gol. II/ d Rp 2,507,800 25 3 1 28
17 BAGUS SANTOSO,AMd.PK Gol. II/ d Rp 2,507,800 25 3 1 28
18 KHUMAIDAH, Amd.PK Gol. II/ d Rp 2,507,800 25 3 1 28
19 WASIUL MUFIDAH Gol. II/ c Rp 2,989,300 29 5 1 34
20 ISMI WARDINI Gol. II/ c Rp 2,989,300 29 5 1 34
21 LILIK ASFIYAH Gol. II/ c Rp 2,989,300 29 5 1 34
22 AULIA BUDI RAHAYU Gol. III/ a Rp 3,349,800 33 5 1 38
23 MUSYARIYAH BLUD Rp. 1.662.393/2.192.200 21 4 1 25
24 SUTATIK LAFIANA BLUD Rp. 1.662.393/2.192.200 21 4 1 25
25 MUH. ZAKIYUDIN BLUD Rp. 1.505.340/1.926.000 19 5 1 24
26 NOVI MUHAIMIN BLUD Rp. 1.505.340/1.926.000 19 5 1 24
27 INDRA KURNIAWAN BLUD Rp. 1.505.340/1.926.000 19 5 1 24
28 EKA REFFA YULIA ARIFIN BLUD Rp. 1.440.741/2.192.200 21 3 1 24
29 MOCH. BASOIR BLUD Rp. 1.440.741/2.192.200 21 3 1 24
30 LELIYANA TRI ARIFIYANITA (CUTI) BLUD Rp. 1.003.560/1.926.000 19 2 1 21
31 SUGENG PRASTYO M., A.Md.PK. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
32 IMAM SYAFI'I BLUD Rp. 1.003.560/1.926.000 19 2 1 21

Page 3 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
33 ADITYA WAHYU PRIYANDINI BLUD Rp. 1.108.262/2.192.200 21 2 1 23
34 INTIJAS JOHARI, S.Sos Gol. III/ d Rp 4,162,900 41 5 1 46
35 WARI Gol. III/ b Rp 3,601,400 36 5 1 41
36 SUWARTINI Gol. II/ c Rp 3,083,400 30 5 1 35
37 LILIK YULIANI, SE Gol. III/ c Rp 3,214,700 32 5 1 37
38 ASMAUL KHUSNAH Gol. II/ c Rp 2,989,300 29 5 1 34
39 KASIYAM Gol. II/ c Rp 2,723,700 27 5 1 32
40 NURUL AINIYAH Gol. II/ c Rp 2,989,300 29 5 1 34
41 AHMAD NAJIH Gol. II/ b Rp 2,456,000 24 5 1 29
42 BAMBANG SISWANTO A Gol. II/ b Rp 2,456,000 24 5 1 29
43 ANTON FEBIANTO BLUD Rp. 1.304.628/1.926.000 19 3 1 22
44 NAFIATUS SHOLIHAH, SKM BLUD Rp. 1.219.768/2.456.700 24 2 1 26
45 NOVI FUJI LESTARI, A.Md. BLUD Rp. 1.440.741/2.192.200 21 3 1 24
46 CHANDRA GERRY PRASETYA BLUD Rp. 1.304.628/1.926.000 19 3 1 22
47 MEITA WULAN SARI BLUD Rp. 1.505.340/1.926.000 19 5 1 24
48 ERMIN NURHAYATI, Amd.RM Gol. III/ c Rp 3,116,500 31 5 1 36
49 IVA SUSANTI Gol. II/ c Rp 2,898,000 28 5 1 33
50 DEDDY ARYADI MOELYA BLUD Rp. 1.585.698/2.456.700 24 3 1 27
51 NANIK SA'DIYAH BLUD Rp. 1.585.698/2.456.700 24 3 1 27
52 NURUL FARIDA BLUD Rp. 1.304.628/1.926.000 19 3 1 22
53 HUDHAN ADHAJULI, A.Md BLUD Rp. 1.219.088/2.192.200 21 2 1 23
54 ENNY KARUNIA WULAN SARI BLUD Rp. 1.103.916/1.926.000 19 2 1 21
55 UMAR SOFYAN BLUD Rp. 1.103.916/1.926.000 19 2 1 21
56 LILLAH KHAFIDHA BLUD Rp. 1.103.916/1.926.000 19 2 1 21
57 FARID AHMAD NURIYANTO BLUD Rp. 1.003.560/1.926.000 19 1 1 20
58 AHMAD SA'DAN, A.Md.PK (baru) BLUD Rp. 1.108.262/2.192.200 21 1 1 22
IV BIDANG YANMED
1 dr. WIWIK TRI RAHAYUNINGSIH Gol. III/ d Rp 4,035,800 40 5 1 45
2 dr. SANTI RAHAYU Gol. III/ c Rp 2,929,100 29 3 1 32
3 AMANU, S.Kep Ners Gol. III/ d Rp 3,667,300 36 5 1 41
4 ERVIN INAYAH, SKM Gol. III/ c Rp 3,315,900 33 5 1 38
5 FATMAWATI Gol. II/ c Rp 2,989,300 29 5 1 34
6 DIMAS MUFTIFACHRIZAL BLUD Rp. 1.829.652/2.456.700 24 5 1 29

Page 4 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
7 BERRY PUTRA DWI H., SKM BLUD Rp. 1.341.745/2.456.700 24 2 1 26
8 YAN KHARIS DARMAWAN, SH BLUD Rp. 1.219.768/2.456.700 24 2 1 26
9 GADIS WISUDAWATI YUNIA PUTRI, SKM BLUD Rp. 1.219.768/2.456.700 24 2 1 26
V BIDANG PENUNJANG MEDIK

1 drg.JOELYATI Gol. IV/ b Rp 4,522,500 45 4 1 49
2 ANIK SUSIAMI, SKM Gol. III/ d Rp 3,912,600 39 3 1 42
3 ANNY LATHIFAH,S Si. Apt Gol. III/ d Rp 3,456,200 34 5 1 39
4 METY SETYANINGRUM Gol. II/ b Rp 2,533,400 25 5 1 30
5 ABDUL AZIZ Gol. II/ b Rp 2,456,000 24 5 1 29
6 FIRMAN BUDI UTOMO, SE BLUD Rp. 1.829.652/2.456.700 24 5 1 29
VI BIDANG KEPERAWATAN
1 ENDANG TUGASWATI, S.Kep.Ners Gol. IV/ a Rp 4,475,700 44 5 1 49
2 NASRUL ULUMIYAH, S.Kep.Ners Gol. III/ d Rp 4,162,900 41 2 1 43
3 SUPARMAN, S.Kep Ners Gol. III/ d Rp 4,162,900 41 2 1 43
4 NINIK WIJAYANTI Gol. II/ c Rp 2,989,300 29 5 1 34
5 MUH. MIFTAHUL ULUM, SKM BLUD Rp. 1.829.652/2.456.700 24 5 1 29
6 DIAN APRILIA ARIANI, S.KEP.NS BLUD Rp. 1.219.768/2.456.700 24 1 1 25
UNIT PEMASARAN
1 PURWATI, SKM Gol. III/ d Rp 3,677,300 36 5 1 41
2 SUSILO, SKM Gol. III/ c Rp 3,420,300 34 5 1 39
3 FITRI AISYAH, SKM BLUD Rp. 1.219.768/2.456.700 24 2 1 26
4 AFIFA AGUSTINE HADINI, A.Md BLUD Rp. 1.108.262/2.192.200 21 1 1 22
I RUANG ANGGREK
1 WIWIK WAHYUNINGSIH,AMK Gol. III/ d Rp 4,162,900 41 5 1 46
2 RETNO YUNIATI,S.Kep.Ners Gol. III/ d Rp 3,677,300 36 5 1 41
3 RIFDATUL MAULA Gol. III/ c Rp 3,116,500 31 5 1 36
4 DENI YUNI ASTUTI Gol. II/ d Rp 2,928,300 29 5 1 34
5 ERMAWATI Gol. II/ c Rp 2,989,300 29 5 1 34
6 SITI AMINAH, AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
7 SITI MUAFAROH BLUD Rp. 1.662.393/2.192.200 21 4 1 25

Page 5 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
8 DEVY DWI EKAWATI BLUD Rp. 1.662.393/2.192.200 21 5 1 26
9 MAULA DWI RISKA, S.Kep.Ners BLUD Rp. 1.829.652/2.456.700 24 4 1 28
10 NURUL HIDAYATI BLUD Rp. 1.440.741/2.192.200 21 3 1 24
11 ISTIRSHA HENDRIANA BLUD Rp. 1.662.393/2.192.200 21 4 1 25
12 EVY ANA RAKHMAWATI, S.Kep.Ns BLUD Rp. 1.341.745/2.456.700 24 2 1 26
13 SUHARNIK, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
14 MOH. AS'AD BLUD Rp. 1.440.741/2.192.200 21 3 1 24
15 MIFTAKHUN NIKMAH, A.Md.Kep BLUD Rp. 1.108.262/2.192.200 21 1 1 22
16 NILA ARIESTA OLVIA FITRIANA, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 1 1 22
17 DWI PUTRI CITA WULANDARI, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 1 1 22
II RUANG BOUGENVIL
1 NUROHMAH Gol. III/ d Rp 4,035,800 40 5 1 45
2 MUDJIATI Gol. III/ d Rp 4,162,900 41 5 1 46
3 SRI HARINI, Amd Keb Gol. III/ c Rp 3,116,500 31 5 1 36
4 TITIEK DIAN NUGRAHENI Gol. II/ d Rp 2,928,300 29 5 1 34
5 ANIS TIANAH Gol. II/ c Rp 3,083,400 30 5 1 35
6 SUTARMI Gol. I/ c Rp 2,038,100 20 5 1 25
7 AFIFAH Gol. III/ a Rp 2,959,000 29 5 1 34
8 ANNISA DWI OKTARIA Gol. III/ a Rp 2,959,000 29 5 1 34
9 NURUL HIDAYAH Gol. II/ c Rp 3,083,400 30 5 1 35
10 INDIE DIYANAH, A.Md.Keb Gol. II/ d Rp 2,507,800 25 1 1 26
11 LILIK ANIAWATI,Amd Keb. BLUD Rp. 1.662.393/2.192.200 21 5 1 26
12 DWI RAHMAH Y, A.md.Keb. BLUD Rp. 1.662.393/2.192.200 21 5 1 26
13 RIRIN FAIDLOTUR ROHMA BLUD Rp. 1.662.393/2.192.200 21 4 1 25
14 EVA ANIS,Amd Keb. BLUD Rp. 1.662.393/2.192.200 21 5 1 26
15 NAILUL FAUZIYAH, AMd.Keb Gol. II/ d Rp 2,613,800 26 3 1 29
16 YULI KINTARTI, Amd.Keb Gol. II/ d Rp 2,507,800 25 3 1 28
17 ZAHRINA, Amd.Keb BLUD Rp. 1.662.393/2.192.200 21 4 1 25
18 HALIMATUS SA'DIYAH, AMd.Keb BLUD Rp. 1.662.393/2.192.200 21 4 1 25
19 UMU UCHLISOTIN, A.Md.Keb (CUTI) BLUD Rp. 1.440.741/2.192.200 21 3 1 24
20 DESSY RATNASARI PUTRI BLUD Rp. 1.440.741/2.192.200 21 3 1 24
21 DIAH NOVITA SARI, A.Md.Keb. BLUD Rp. 1.662.393/2.192.200 21 4 1 25
22 NUR FARIDA ZUNAINI BLUD Rp. 1.440.741/2.192.200 21 3 1 24

Page 6 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
23 NISA'ANA YULIANI BLUD Rp. 1.440.741/2.192.200 21 3 1 24
24 ZUMRUDDAH, A.Md.Keb. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
25 ROSY ROSYIDAH AYU J., A.Md.Keb. (CUTI) BLUD Rp. 1.108.262/2.192.200 21 2 1 23
26 NAILIL YUSROHTOL ISNAINI, A.Md.Keb. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
27 ASTINIK FEBRIANI, A.Md.Keb. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
28 ROHMATUL JANNAH, A.Md.Keb. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
III RUANG NEONATUS

1 YULIANAH, S.Kep.Ns Gol. IV/ a Rp 4,475,700 44 5 1 49
2 TUTIK PURWATI Gol. IV/ a Rp 3,953,600 39 5 1 44
3 FAUZIYAH Gol. III/ d Rp 3,677,300 36 5 1 41
4 LAILI ISTIQOMI Gol. III/ b Rp 3,084,200 30 5 1 35
5 NUR HIDAYATI Gol. III/ b Rp 3,084,200 30 5 1 35
6 NAFI'ATUN Gol. III/ a Rp 2,959,000 29 5 1 34
7 INDAH SULISTIYOWATI Gol. III/ a Rp 2,959,000 29 5 1 34
8 SITI CHOTIMAH Gol. III/ a Rp 2,868,700 28 5 1 33
9 SITI SHOLIKAH Gol. III/ a Rp 2,959,000 29 5 1 34
10 MUKHLISHOTIN Gol. III/ a Rp 2,868,700 28 5 1 33
11 MITA INDAH LESTARI Gol. III/ a Rp 2,868,700 28 5 1 33
12 SRI HARTUTIK Gol. II/ c Rp 3,083,400 30 5 1 35
13 YASTUNIK Gol. II/ c Rp 2,989,300 29 5 1 34
14 AFRILIANA EKASARI BLUD Rp. 1.662.393/2.192.200 21 4 1 25
15 MUNAWAROH BLUD Rp. 1.310.585/1.533.400 15 5 1 20
16 MUZAWATI, Amd Kep. BLUD Rp. 1.662.393/2.192.200 21 4 1 25
17 CHUSNUL CHOTIMAH, S.ST BLUD Rp. 1.829.652/2.456.700 24 3 1 27
18 ANITA AMALIYA BLUD Rp. 1.440.741/2.192.200 21 3 1 24
19 SHOLIHATUL WAHYUNA BLUD Rp. 1.440.741/2.192.200 21 3 1 24
20 EZZATUL OLYA, S.Kep.Ns (CUTI) BLUD Rp. 1.829.652/2.456.700 24 3 1 27
21 WAKHDIAH RETNO A. BLUD Rp. 1.440.741/2.192.200 21 3 1 24
22 ARUM AYU NING TIAS, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 1 1 22
23 AGUSTY DIYAH NUR PANCARANI, A.Md.K BLUD Rp. 1.108.262/2.192.200 21 1 1 22
24 IRMA ZUHROTUL LAILY MASA, S.Kep.Ns BLUD Rp. 1.219.768/2.456.700 24 1 1 25
25 SULIS NOVITA HANUM, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 1 1 22

Page 7 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
IV RUANG CEMPAKA
1 RIWAHTINI,S.Kep.Ners Gol. IV/ b Rp 4,665,000 46 5 1 51
2 MARDIANA, S.Kep.Ners Gol. III/ b Rp 2,810,200 28 2 1 30
3 SRI PUJIASTUTI, A.Md.Kep. Gol. III/ b Rp 3,084,200 30 2 1 32
4 USWATUN HASANAH Gol. II/ d Rp 2,752,300 27 5 1 32
5 MAFULAH Gol. II/ c Rp 3,083,400 30 5 1 35
6 ERNA WINARTI Gol. II/ c Rp 2,898,000 28 5 1 33
7 CICIK SUCIATI, AMd.Kep Gol. II/ d Rp 2,507,800 25 3 1 28
8 YANTI TKM Rp. 1.446.963/1.692100 16 5 1 21
9 ANIS YUNIATI,AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
10 KUKUH ADI NURANTO,AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
11 AINUL HUSNA BLUD Rp. 1.662.393/2.192.200 21 4 1 25
12 DIAN SUSILOWATI BLUD Rp. 1.662.393/2.192.200 21 4 1 25
13 SUJALANI BLUD Rp. 1.310.585/1.533.400 15 5 1 20
14 BUDI IRAWAN, Amd.Kep BLUD Rp. 1.662.393/2.192.200 21 4 1 25
15 ADAM ARIF SETIAWAN, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
16 ANDIK AHMAD YUSUF, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
17 A'NUR AGA SANDI PRAHARA, S.Kep. BLUD Rp. 1.341.745/2.456.700 24 2 1 26
18 INDAH CRYS SAFAATI, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
19 ONY WIDYA LESTARI, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
20 ELLY NURFITA ZAIZIN, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
21 ANGGA PUTRA PRATAMA, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 1 1 22
22 URWAH SITI SAFIYAH, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 1 1 22
V RUANG DAHLIA
1 ERLIK ROKHANA, S.Kep.Ners Gol. IV/ b Rp 4,811,900 48 5 1 53
2 HERLINAWATI Gol. III/ d Rp 3,912,600 39 5 1 44
3 SRI LUKITANINGSIH, Amd.Kep Gol. III/ a Rp 2,959,000 29 5 1 34
4 SULISTIYOWATI Gol. II/ c Rp 2,898,000 28 5 1 33
5 ENNI ISTIYAWATI Gol. II/ c Rp 3,083,400 30 5 1 35
6 SRI ROHMAH,AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
7 TADZKIROH, AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
8 DEDIK BUDI LAKSONO,AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
9 SAMINAH BLUD Rp. 1.310.585/1.533.400 15 5 1 20

Page 8 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
10 EKA RETNOWATI, AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
11 NUNUK SULISTIAWATI, AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
12 RIA RAHMAWATI, AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
13 ANISWATIN CHOIRIYAH BLUD Rp. 1.662.393/2.192.200 21 5 1 26
14 DANIAL FARUQ, S.Kep.Ns BLUD Rp. 1.585.698/2.456.700 24 3 1 27
15 SUMARTONO, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
16 INDRA SETIYAWAN, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
17 MUSLIM GHOFUR, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
18 NUR LAILATUL QODHARIA, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
19 AINUL ROFIK, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
20 HENDRA PRATAMA, S.Kep.Ns BLUD Rp. 1.219.768/2.456.700 24 1 1 25
21 MUHAMMAD HARDIYANTO, S.Kep.Ns BLUD Rp. 1.219.768/2.456.700 24 1 1 25
22 ASMAUL KHUSNAH, A.Md.Kep BLUD Rp. 1.108.262/2.192.200 21 1 1 22
23 KEZIAH PUTRI OETARI, A.Md.Kep BLUD Rp. 1.108.262/2.192.200 21 1 1 22
24 MUHAMMAD FADLI YASIN, A.Md.Kep BLUD Rp. 1.108.262/2.192.200 21 1 1 22
25 SULISTIYONINGSIH, A.Md.Kep BLUD Rp. 1.108.262/2.192.200 21 1 1 22
26 SYAIFUL ISLAM, A.Md.Kep BLUD Rp. 1.108.262/2.192.200 21 1 1 22
27 ARIF DIKA MAHENDRA, S.Kep.Ns BLUD Rp. 1.219.768/2.456.700 24 1 1 25
VI RUANG EDELWEIS
1 KHUSNUL RIFA'I, S.Kep.Ners Gol. IV/ a Rp 3,832,800 38 5 1 43
2 ANAH, AMK Gol. III/ a Rp 2,868,700 28 5 1 33
3 SITI RAHAYUH Gol. III/ a Rp 2,868,700 28 5 1 33
4 INTAN FITRIA HARTONO Gol. III/ a Rp 2,868,700 28 5 1 33
5 DWI WINARSIH Gol. II/ d Rp 2,752,300 27 5 1 32
6 RAHMI NURJAYANI WIDODO BLUD Rp. 1.662.393/2.192.200 21 4 1 25
7 RENI DWI OKTAFIANI, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
8 BACHTIAR, S.Kep. BLUD Rp. 1.341.745/2.456.700 24 2 1 26
9 PUTRI EMILIA LUTHFIANAH, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
10 SARI RAHMAWATI Gol. II/ c Rp 2,989,300 29 5 1 34
11 IRMA MIFTACHUR ROZIDA, S.Kep.Ns BLUD Rp. 1.585.698/2.456.700 24 3 1 27
12 ARIE SATRIA WISUDAWAN, S.Kep.Ns BLUD Rp. 1.219.768/2.456.700 24 1 1 25
13 ISTIYA TRI RAHAYUNINGSIH, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 1 1 22
14 FATIMATUS ZUHRIYA, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 1 1 22

Page 9 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
15 MOH. ENDIK SUJAD ENDRA PRASTYA, A. BLUD Rp. 1.108.262/2.192.200 21 1 1 22
16 DESY ANA KURNIASTUTI, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 1 1 22
VII RUANG FLAMBOYAN

1 SRI RAHAYUNINGSIH, S.Kep.Ners Gol. IV/ a Rp 4,078,100 40 5 1 45
2 PURTAJI, S.Kep.Ners Gol. III/ d Rp 3,565,000 35 5 1 40
3 DYAH AYU RATNANINGRUM, Amd.Kep Gol. II/ d Rp 2,928,300 29 5 1 34
4 UMMI KURNIYAH, Amd.Kep Gol. II/ d Rp 2,507,800 25 3 1 28
5 FENY INDRIYANI, Amd.Kep Gol. II/ d Rp 2,507,800 25 3 1 28
6 MULIYANAH Gol. II/ c Rp 2,989,300 29 5 1 34
7 SISWATI Gol. II/ a Rp 2,667,500 26 5 1 31
8 AZIZATUL MASRUROH, Amd.Kep BLUD Rp. 1.662.393/2.192.200 21 4 1 25
9 DIANA ERVIANA, Amd.Kep BLUD Rp. 1.662.393/2.192.200 21 4 1 25
10 ENY QURROTUL. A,Amd.Kep BLUD Rp. 1.662.393/2.192.200 21 5 1 26
11 NUR KHOYIBAH BLUD Rp. 1.446.963/1.692100 16 5 1 21
12 LIA SULFIATUN NIKMAH BLUD Rp. 1.440.741/2.192.200 21 2 1 23
13 ANDRI SEPTIANTO, Amd.Kep BLUD Rp. 1.440.741/2.192.200 21 3 1 24
14 AGIL ARI SAPUTRO, Amd.Kep BLUD Rp. 1.440.741/2.192.200 21 3 1 24
15 FAJAR AYU AGUSTINA, AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
16 RULLY ANDIARISCA, S.Kep.Ns BLUD Rp. 1.585.698/2.456.700 24 3 1 27
17 MUHAMAD MARZUKI, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
18 AINUNG ASTATIK, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
19 HALIMATUS SA'DIYAH, A.Md.Kep. (CUTI) BLUD Rp. 1.108.262/2.192.200 21 2 1 23
20 FERI DWI SUPRIYANTO, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
21 M.ROZIKUL UMAM, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
VIII RUANG OBSERVASI LANJUTAN

1 IDAYANI, AMd.Kep Gol. III/ c Rp 3,116,500 31 5 1 36
2 RINI SUSANTI,AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
3 DIANA ROCHMAWATI,AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
4 DESSITA WAHYU A, AMd.Kep BLUD Rp. 1.662.393/2.192.200 21 5 1 26
5 MOCH. YANI ARIF, AMd.Kep BLUD Rp. 1.662.393/2.192.200 21 5 1 26
6 RANDY YOGI DWI PERMANA, S.KEP.NS BLUD Rp. 1.219.768/2.456.700 24 1 1 25
7 SUHENDRIK ADI PRAYITNO, S,KEP.NS BLUD Rp. 1.219.768/2.456.700 24 1 1 25

Page 10 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
8 PURWATI NINGSIH, A.Md.Kep BLUD Rp. 1.108.262/2.192.200 21 1 1 22
9 ALI MURTADLO, S.Kep.Ns BLUD Rp. 1.219.768/2.456.700 24 1 1 25
10 NURUL KAMAJAYA CHANDRA AGUSTINA, BLUD Rp. 1.219.768/2.456.700 24 1 1 25
IX RUANG LANTAI IV
1 SUNARTIK ,S.Kep.Ners Gol. IV/ a Rp 4,206,500 42 5 1 47
2 SUNARTI, Amd.Kep Gol. III/ a Rp 2,868,700 28 5 1 33
3 MAUDLUAH Gol. II/ c Rp 2,723,700 27 5 1 32
4 BUNGA ASRI MAULIDA, Amd.Kep BLUD Rp. 1.662.393/2.192.200 21 5 1 26
5 LILIK YULIANA, Amd.Kep BLUD Rp. 1.440.741/2.192.200 21 2 1 23
6 DIAN ARI CAHYANI, AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
7 KHOLIDATUL HASANAH, Amd.Kep BLUD Rp. 1.662.393/2.192.200 21 5 1 26
8 TRI YULIANI, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
9 NIZAR AVIARGO PERMANA, S.KEP.NS BLUD Rp. 1.219.768/2.456.700 24 1 1 25
10 A.AGIN ZAINAL MUSTAFA, A.Md.Kep BLUD Rp. 1.108.262/2.192.200 21 1 1 22
11 ROIKHATUL JANNAH, S,Kep.Ns (CUTI) BLUD Rp. 1.219.768/2.456.700 24 1 1 25
12 SYIANAH (CUTI) BLUD Rp. 1.310.585/1.533.400 15 5 1 20
13 YUNIAR ANDRIANY, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 1 1 22
X RUANG GARDENA
1 IDA MUHLISAH, S.Kep.Ners Gol. IV/ a Rp 4,078,100 40 5 1 45
2 WITJAYATI, AMd.Kep Gol. III/ a Rp 2,868,700 28 5 1 33
3 DWI RAHAYU AMPERAWATI Gol. II/ c Rp 2,989,300 29 5 1 34
4 AMINATUL JUHROH, AMd.Kep Gol. II/ d Rp 2,507,800 25 3 1 28
5 WIDHI ASTUTIK .R Gol. II/ d Rp 2,838,900 28 5 1 33
6 RENI PURNAMA SARI, AMd.Kep BLUD Rp. 1.662.393/2.192.200 21 4 1 25
7 IIS SURYANINGSIH, AMd.Kep BLUD Rp. 1.662.393/2.192.200 21 5 1 26
8 MARSANI BLUD Rp. 1.310.585/1.533.400 15 5 1 20
9 AHMAD FADIL, AMd.Kep BLUD Rp. 1.662.393/2.192.200 21 4 1 25
10 HENNY BHINEKAWATI, AMd.Kep BLUD Rp. 1.662.393/2.192.200 21 4 1 25
11 LUTHFIYANI ACHIDYA H., AMd.Kep BLUD Rp. 1.440.741/2.192.200 21 3 1 24
12 TULUS HERMAWAN, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
13 INDRI WAHYUNI, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
14 NASHOHAN, S.Kep,Ns BLUD Rp. 1.219.768/2.456.700 24 1 1 25

Page 11 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
15 VRISKA TRISTIANTIKA, A.Md.Kep BLUD Rp. 1.108.262/2.192.200 21 1 1 22
16 ADINDA MAWADA RAHMA, S.Kep.Ns BLUD Rp. 1.219.768/2.456.700 24 1 1 25
17 EVI RIFQIYATUL MAHFUDHOH, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 1 1 22
18 HABIB PUTRA PRADANA, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 1 1 22
XI RUANG HELICONIA
1 NANIK, S.Kep.Ners Gol. IV/ a Rp 4,078,100 40 5 1 45
2 SUYATMI Gol. III/ d Rp 3,912,600 39 5 1 44
3 SUTATIK Gol. II/ c Rp 2,989,300 29 5 1 34
4 IDHA IFFATI NINGSIH, AMd.Kep Gol. II/ d Rp 2,507,800 25 3 1 28
5 EDI PURWANTO, AMd.Kep. Gol. III/ a Rp 2,781,100 27 5 1 32
6 NANIK INDAH YANTI Gol. II/ c Rp 2,640,600 26 5 1 31
7 MUKENI BLUD Rp. 1.310.585/1.533.400 15 5 1 20
8 WINARTI PUJI R, S.Kep.Ners BLUD Rp. 1.829.652/2.456.700 24 4 1 28
9 ERVA WIDIASTUTI F, AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
10 ISROFAH, AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
11 IDYAH HEFFI NINGSIH, AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
12 WIWIK NURUL SITI KHOLIFAH, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
13 ISNAINI, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
14 AQUARISTA WIDYA LUTFI, A.Md.Kep BLUD Rp. 1.108.262/2.192.200 21 1 1 22
15 LINDA ROZIA NINGSIH, A.Md.Kep BLUD Rp. 1.108.262/2.192.200 21 1 1 22
16 FENNY LARASATI, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 1 1 22
17 NURUL HIDAYATI, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 1 1 22
XII RUANG WIJAYA KUSUMA

1 SITI MAHMUDAH, S.Kep.Ners (CUTI HAJI) Gol. IV/ a Rp 3,953,600 39 5 1 44
2 HERNAWATI, S.ST Gol. III/ b Rp 2,810,200 28 2 1 30
3 DWI YUNIASIH, AMK Gol. III/ b Rp 2,898,700 28 5 1 33
4 SRI UTAMI Gol. II/ d Rp 3,020,600 30 5 1 35
5 RITA LUVIA Gol. II/ c Rp 2,723,700 27 5 1 32
6 VIDIYA WATI,AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
7 FITRA WAHYUDI HS, Amd.Kep BLUD Rp. 1.662.393/2.192.200 21 4 1 25
8 NUR LAILI WAHIYANIDDAH, AMK BLUD Rp. 1.662.393/2.192.200 21 4 1 25
9 DWI RAHAYU BLUD Rp. 1.662.393/2.192.200 21 4 1 25

Page 12 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
10 LULUK MAHFIRROH, A.Md.Kep. (CUTI) BLUD Rp. 1.108.262/2.192.200 21 2 1 23
11 YAYAN DWI KISWANTO, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
12 YULIANI, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
13 YAYUK JUMA'ATUN, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
14 BUDI SETYAWAN, S.KEP.NS BLUD Rp. 1.219.768/2.456.700 24 1 1 25
15 DIDIN CHUSLILLAH, A.Md.Kep BLUD Rp. 1.108.262/2.192.200 21 1 1 22
16 NELLY FATMAWATI, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 1 1 22
17 ROSE DIANA SETYA NINGSIH, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
18 MOCHAMMAD THESAR, S.Kep.Ns BLUD Rp. 1.219.768/2.456.700 24 1 1 25
19 HANIK AMANAH BLUD Rp. 1.446.963/1.692100 16 5 1 21
XIII INSTALASI BEDAH SENTRAL / OK

1 SUHARTOYO, S.Kep.Ners Gol. IV/ b Rp 4,665,000 46 5 1 51
2 SITI RUKHANAH Gol. III/ d Rp 4,162,900 41 5 1 46
3 MARCISWATI, AMd.Kep Gol. III/ d Rp 4,294,000 42 5 1 47
4 SRI RAHAYU, A.Md.Keb. Gol. III/ d Rp 4,035,800 40 5 1 45
5 ANWAR SHODIQ, S.Kep.Ners Gol. III/ d Rp 3,677,300 36 5 1 41
6 SUYANTO, S.Kep.Ns Gol. IV/ a Rp 3,953,600 39 5 1 44
7 DARUS, AMd.Kep Gol. III/ d Rp 3,565,000 35 5 1 40
8 AHMAD RIFA'I, S.Kep.Ners Gol. III/ d Rp 3,677,300 36 5 1 41
9 LUQMAN HAKIM, S.Kep.Ners Gol. III/ d Rp 3,565,000 35 5 1 40
10 ARIF KURNIAWAN, S.Kep.Ners Gol. III/ c Rp 3,315,900 33 5 1 38
11 HAFSAH SUTRISNO, AMd.Kep Gol. III/ b Rp 3,181,300 31 5 1 36
12 DIDIK NOVIANTO FADELI, AMd.Kep Gol. III/ a Rp 2,868,700 28 5 1 33
13 INDANA ZULFA, AMd.Kep Gol. III/ a Rp 2,959,000 29 5 1 34
14 VERY KUMALA DEWI, AMd.Kep Gol. III/ a Rp 2,868,700 28 5 1 33
15 WAHYU HADI PURWANTO, AMd.Kep Gol. III/ a Rp 2,959,000 29 5 1 34
16 SHOLIKIN Gol. II/ c Rp 3,083,400 30 5 1 35
17 MOCHAMAD MUSTA'IN, AMd.Kep Gol. II/ d Rp 3,020,600 30 5 1 35
18 MUHAMMAD ALI Gol. II/ c Rp 3,083,400 30 5 1 35
19 DARTIK YULIANTI, Amd.Keb Gol. III/ a Rp 2,696,200 26 3 1 29
20 MOH. TRILAKSANA Gol. III/ a Rp 2,868,700 28 3 1 31
21 SUTRISNO, AMd.Kep Gol. II/ d Rp 2,928,300 29 5 1 34
22 PIPIT BAGUS RAHMADHANI BLUD Rp. 1.505.340/1.926.000 19 5 1 24

Page 13 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
23 ACH. FUDI PRASETYO BLUD Rp. 1.505.340/1.926.000 19 5 1 24
24 IWAN PRASETYO BLUD Rp. 1.505.340/1.926.000 19 5 1 24
25 MUJIATI BLUD Rp. 1.446.963/1.692100 16 5 1 21
26 VIRGINA MAHARANI,AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
27 NAWAN HARSONO, S.Kep.Ners BLUD Rp. 1.829.652/2.456.700 24 4 1 28
28 MOCH. IRFAN HASAN, Amd.Kep BLUD Rp. 1.440.741/2.192.200 21 2 1 23
29 BACHRUL ULUM, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
30 MUHAMMAD FATIH, A.Md.Kep BLUD Rp. 1.108.262/2.192.200 21 1 1 22
XIV ANESTESI / RR
1 SUDARMIATI,S.Kep.Ners Gol. IV/ b Rp 4,665,000 46 5 1 51
2 KADIN, S.Kep.Ners Gol. IV/ a Rp 4,078,100 40 5 1 45
3 SITI SA'ADAH, AMd.Kep (CUTI HAJI) Gol. III/ d Rp 3,912,600 39 5 1 44
4 SENAN, AMd.Kep Gol. III/ d Rp 3,677,300 36 5 1 41
5 ATMI PURNAWATI,S.Kep.Ners Gol. III/ d Rp 3,677,300 36 5 1 41
6 QOMARIYAH, A.Md.Kep. Gol. III/ c Rp 3,214,700 32 4 1 36
7 MUMAIYIZAH, Amd.Kep. Ns Gol. III/ b Rp 2,898,700 28 4 1 32
8 SUWALI, AMd.Kep Gol. III/ b Rp 3,491,500 34 5 1 39
9 NUR KHAKIM DEDDY Gol. III/ a Rp 2,781,100 27 5 1 32
10 M. MISBACH, S.T.Kep Gol. III/ a Rp 2,868,700 28 5 1 33
11 MUHAMMAD FAHMI, AMd.Kep Gol. III/ a Rp 2,868,700 28 5 1 33
12 ENDAH AYU TRI W., AMd.Kep Gol. III/ a Rp 2,868,700 28 5 1 33
13 NANANG EKO PURWONO, AMd.Kep Gol. II/ d Rp 2,752,300 27 5 1 32
14 FITOS WIDYANTO, AMd.Kep Gol. III/ a Rp 2,868,700 28 5 1 33
XV UNIT STERILISASI SENTRAL

1 NYIMAS INDAH AMILAH, Apt Gol. IV/ a Rp 3,492,400 34 5 1 39
2 ABDUL KOLIS Gol. II/ a Rp 2,838,200 28 5 1 33
3 SYAMSUL ARIFIN BLUD Rp. 1.505.340/1.926.000 19 2 1 21
4 RIANTONO BLUD Rp. 1.505.340/1.926.000 19 2 1 21
5 DWI CAHYONO BLUD Rp. 1.505.340/1.926.000 19 2 1 21
XV INSTALASI ICU
1 MACHFOED, AMd.Kep Gol. III/ d Rp 3,677,300 36 5 1 41

Page 14 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
2 NURUD DIYANAH,S.Kep Gol. III/ d Rp 3,677,300 36 5 1 41
3 MUSTAKIM JUNAIDI, AMd.Kep Gol. III/ c Rp 3,315,900 33 5 1 38
4 IMAM SYAFI'I, AMK Gol. III/ d Rp 3,456,200 34 5 1 39
5 FIRDAUS ZUNAEDI, AMd.Kep Gol. III/ b Rp 3,084,200 30 5 1 35
6 MOCH. YUSUF, AMd.Kep Gol. III/ b Rp 3,281,500 32 5 1 37
7 ULIFAH, AMd.Kep Gol. III/ b Rp 3,281,500 32 5 1 37
8 KISWANTO, AMd.Kep Gol. III/ a Rp 2,868,700 28 5 1 33
9 RUMIATI, AMd.Kep Gol. II/ d Rp 2,928,300 29 5 1 34
10 INDRA NOPIAWATI, AMd.Kep (CUTI) Gol. III/ a Rp 2,868,700 28 5 1 33
11 HUSNI HIMMAHAYATI, AMd.Kep Gol. II/ d Rp 2,507,800 25 3 1 28
12 PRAMITA SARI, Amd.Kep Gol. II/ d Rp 2,507,800 25 3 1 28
13 HADI SUCIPTO Gol. II/ c Rp 3,083,400 30 5 1 35
14 ESTI ANGGRAINI,AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
15 SANTI QURNIAWATI,AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
16 HIJRAH SAPUTRA, AMd.Kep BLUD Rp. 1.662.393/2.192.200 21 4 1 25
17 IZATUR RAHMAWATI, AMd.Kep BLUD Rp. 1.662.393/2.192.200 21 4 1 25
18 SUMIAH, S.Kep.Ners Gol. III/ b Rp 3,491,500 34 5 1 39
19 IIN SURYANI,AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
20 NUR HALIMAH, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
21 INDAH NURHAYATI, S.Kep.Ns BLUD Rp. 1.219.768/2.456.700 24 1 1 25
22 JULIENAVITA ADINDA, S.Kep.Ns BLUD Rp. 1.219.768/2.456.700 24 1 1 25
23 NURUL FADILAH, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 1 1 22
24 MOH. FARIHIN, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 1 1 22
XVI INSTALASI GAWAT DARURAT

1 NUR FADLILAH, AMd.Kep Gol. III/ d Rp 3,793,100 37 5 1 42
2 HAMID ROHMAN, AMd.Kep Gol. III/ d Rp 3,677,300 36 5 1 41
3 R. AHMAD BASHOFI, AMd.Kep Gol. III/ c Rp 3,315,900 33 5 1 38
4 MAKRUF, AMd.Kep Gol. III/ d Rp 3,677,300 36 5 1 41
5 MASRIKAN, S.Kep.Ners Gol. III/ d Rp 3,677,300 36 5 1 41
6 AHMAD SYAFI'I, AMd.Kep Gol. III/ b Rp 3,084,200 30 5 1 35
7 PRIESTIN DIAN PRAWESTY Gol. III/ a Rp 2,959,000 29 5 1 34
8 ZAINUL BASYAR, AMd.Kep Gol. III/ a Rp 2,868,700 28 5 1 33
9 SIGIT HENDRO RACHMAWAN, AMd.Kep Gol. III/ a Rp 2,868,700 28 5 1 33

Page 15 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
10 KOESNONO EDI SUCIPTO Gol. III/ a Rp 2,868,700 28 5 1 33
11 EMY SURYANINGSIH Gol. III/ a Rp 2,959,000 29 5 1 34
12 JAUHARI SYAMSUDIN, AMd.Kep Gol. III/ a Rp 2,868,700 28 5 1 33
13 TARI HARIYAH Gol. II/ c Rp 2,989,300 29 5 1 34
14 SRI WAHYUNINGSIH BLUD Rp. 1.505.340/1.926.000 19 5 1 24
15 ENIK NUR ISMIYATI, AMd.Kep BLUD Rp. 1.662.393/2.192.200 21 4 1 25
16 M. FAHRUR ROHAJI, AMd.Kep BLUD Rp. 1.440.741/2.192.200 21 3 1 24
17 LILIS FAUZIYAH Gol. II/ c Rp 2,723,700 27 5 1 32
18 HARTINI BLUD Rp. 1.505.340/1.926.000 19 5 1 24
19 RIZKA, Amd.Keb. Gol. II/ d Rp 2,507,800 25 3 1 28
20 AHMAD TAUFIQ, AMd.Kep BLUD Rp. 1.662.393/2.192.200 21 4 1 25
21 UBAIDILLAH,Amd.Kep. BLUD Rp. 1.662.393/2.192.200 21 4 1 25
22 SHALEHUDDIN, S.Kep. BLUD Rp. 1.585.698/2.456.700 24 3 1 27
23 MOCH. FIKRI ASLAMI, Amd.Kep BLUD Rp. 1.440.741/2.192.200 21 3 1 24
24 HANDOKO SARIYATNO, AMd.Kep BLUD Rp. 1.440.741/2.192.200 21 3 1 24
25 ALFIYATUL MUFIDAH BLUD Rp. 1.003.560/1.926.000 19 2 1 21
26 MARTHA SISTYA ENDAH W BLUD Rp. 1.829.652/2.456.700 24 5 1 29
27 IVO SHADINA, A.Md.Keb. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
28 ARLIA BUDI ASRI, A.Md.Keb. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
29 TONY BAKHTIAR, AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
30 ERYTA FEBRIANA BLUD Rp. 1.662.393/2.192.200 21 4 1 25
31 HERU CAHYONO, AMd.Kep BLUD Rp. 1.662.393/2.192.200 21 4 1 25
32 ONY SUHANDHI, AMd.Kep BLUD Rp. 1.440.741/2.192.200 21 3 1 24
33 MUHAMMAD AGUS SUUDI, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
34 AWANG ANUGRAH, S.Kep.Ners BLUD Rp. 1.341.745/2.456.700 24 2 1 26
35 NIKEN ANUGRAH KHARISMANINGRUM, A. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
36 SRI WAHYUNI, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
37 MARIA ULFAH, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
38 MUALIFAH,Amd Keb. BLUD Rp. 1.662.393/2.192.200 21 5 1 26
39 IRMAWATI BLUD Rp. 1.440.741/2.192.200 21 3 1 24
40 ANIS FATUL IZZAH BLUD Rp. 1.440.741/2.192.200 21 3 1 24
41 NUR LIA SANTY, A.Md.Keb BLUD Rp. 1.440.741/2.192.200 21 3 1 24
42 IRMA RAKHMAWATI, S.ST BLUD Rp. 1.829.652/2.456.700 24 3 1 27
43 CHOIRUL ARDIANTO, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23

Page 16 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
44 MOHAMMAD JAIZ,Amd.Kep BLUD Rp. 1.662.393/2.192.200 21 4 1 25
45 TEGUH NURDI PRASETYA, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 1 1 22
XVII UNIT HEMODIALISA

1 ANANG MA'RUF, S.Kep.Ners (CUTI HAJI) Gol. III/ d Rp 3,456,200 34 5 1 39
2 MASLACHAH, AMd.Kep Gol. III/ c Rp 3,116,500 31 5 1 36
3 ABDULLAH WASIK Gol. III/ b Rp 3,384,900 33 5 1 38
4 VIRMAN EDI MULJANTO, AMd.Kep Gol. III/ b Rp 3,084,200 30 5 1 35
5 ZAKARIYAH, S.Kep.Ners Gol. III/ b Rp 3,491,500 34 5 1 39
6 SUKARWANTO, AMd.Kep Gol. III/ b Rp 3,052,200 30 5 1 35
7 AKBAR ROCHMAT PRABOWO, AMd.Kep Gol. III/ a Rp 2,959,000 29 5 1 34
8 MUHIBBUDDIN, AMd.Kep Gol. II/ d Rp 2,928,300 29 5 1 34
9 WIWIK HANDAYANI, AMd.Kep Gol. II/ d Rp 3,020,600 30 5 1 35
10 GIYARTINI, AMd.Kep Gol. II/ d Rp 3,020,600 30 5 1 35
11 VIAN SIGIT TRI W,Amd.Kep Gol. II/ d Rp 2,752,300 27 5 1 32
12 BAMBANG SUPRAYITNO, AMd.Kep BLUD Rp. 1.662.393/2.192.200 21 4 1 25
13 SRI MARDIANA BLUD Rp. 1.505.340/1.926.000 19 4 1 23
14 KADEK RASDIKA KRISMAWAN, AMd.Kep BLUD Rp. 1.440.741/2.192.200 21 3 1 24
UNIT ENDOSCOPY
1 SRI LESTARI, S.Kep.Ners Gol. IV/ b Rp 4,250,600 42 5 1 47
2 AGUS PRIYANTO, S.Pd, S.Kep Ners Gol. III/ d Rp 3,677,300 36 5 1 41
3 NURUL CHOIRIYAH, AMd.Kep Gol. II/ d Rp 2,838,900 28 5 1 33
4 RUKIYATI BLUD Rp. 1.505.340/1.926.000 19 4 1 23
POLI ANAK
1 HENY SUYIMAH, Amd.Kep Gol. III/ d Rp 4,035,800 40 5 1 45
2 RIRIS ELIZA DRASTIANA EKA BLUD Rp. 1.585.698/2.456.700 24 3 1 27
POLI TUMBUH KEMBANG

1 ISMIATUL ROHMAH Gol. III/ a Rp 2,959,000 29 5 1 34
POLI PARU
1 MUNTINI, S.Kep.Ns. Gol. IV/ a Rp 4,206,500 42 5 1 47

Page 17 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
2 MULYATI, AMd.Kep Gol. III/ d Rp 4,035,800 40 5 1 45
3 HELEN YUNIAR VERONIKA Gol. III/ a Rp 2,959,000 29 5 1 34
4 SISWANTO Gol. III/ a Rp 2,959,000 29 5 1 34
POLI SARAF
1 MUFADILLA, S.Kep.Ners Gol. IV/ a Rp 3,953,600 39 5 1 44
2 MAZIDATUL HIKMAH, AMK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
POLI BEDAH
1 AHMAD ZAINUL ARIFIN, S.Kep.Ners Gol. IV/ b Rp 4,384,400 43 5 1 48
2 MAS EKO WAHYUDI, AMd.Kep Gol. III/ d Rp 4,035,800 40 5 1 45
3 WIWIK MASHLAHATUL .F Gol. III/ b Rp 3,084,200 30 5 1 35
4 RAHMI INDAH FIRDAUSI, AMd.Kep Gol. II/ d Rp 2,928,300 29 5 1 34
POLI VIP
1 SRI MURNIYATI, Amd.Kep Gol. IV/ a Rp 3,953,600 39 5 1 44
2 ENDANG INDRI ASTUTIK, AMd.Kep Gol. III/ d Rp 3,793,100 37 5 1 42
3 NUR ASYFAH, AMd.Kep Gol. III/ c Rp 3,315,900 33 5 1 38
4 DHEVITA IKA, Amd Keb Gol. III/ a Rp 2,613,800 26 3 1 29
5 HERRY SUPRIYANTO, AMd.Kep Gol. III/ a Rp 2,868,700 28 4 1 32
6 CHOIROTUN NIKMAH, Amd.Kep Gol. II/ d Rp 3,020,600 30 5 1 35
7 HARTOYO, AMd.Kep Gol. II/ d Rp 3,020,600 30 5 1 35
POLI DALAM
1 SRI MUHARNI,AMK Gol. III/ d Rp 4,294,000 42 5 1 47
2 UMU KHOIRIYAH, AMd.Kep Gol. III/ d Rp 3,677,300 36 5 1 41
3 USWATUN CHASANAH, AMK Gol. III/ a Rp 2,868,700 28 5 1 33
4 DYAH KRISTINAWATI, AMd.Kep Gol. II/ d Rp 2,838,900 28 5 1 33
POLI JANTUNG
1 SITI CHARISAH, AMd.Kep Gol. III/ d Rp 4,162,900 41 5 1 46
2 MUHLIS ADI, AMd.Kep Gol. III/ c Rp 3,315,900 33 5 1 38
3 RICA AGUSTINA Gol. III/ a Rp 2,868,700 28 5 1 33
4 NUR HAYATI Gol. II/ d Rp 2,989,300 29 5 1 34

Page 18 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
POLI MATA
1 JAZILATUR ROHMAH, AMd.Kep Gol. III/ d Rp 3,912,600 39 5 1 44
2 NAILUL AMALIEN, AMd.RO Gol. III/ a Rp 2,959,000 29 5 1 34
3 KHIFTUR ROHMANA, AMd.RO Gol. II/ d Rp 2,507,800 25 3 1 28
4 DYAH AYU RAHMAWATI, AMd.RO BLUD Rp. 1.662.393/2.192.200 21 5 1 26
5 DEWI MASRUROH, AMd.Kep. (CUTI) Gol. III/ a Rp 2,959,000 29 5 1 34
6 NUR WACHIDATIN, AMd.RO (CUTI 2 THN) Gol. III/ b Rp 3,001,200 30 5 1 35
7 NUR AZIZAH, A.Md.Kep BLUD Rp. 1.108.262/2.192.200 21 1 1 22
POLI HAMIL
1 MASRIATI, AMd.Keb Gol. III/ d Rp 4,162,900 41 5 1 46
2 FARIDAH, AMd.Keb Gol. III/ d Rp 4,035,800 40 5 1 45
POLI KANDUNGAN
1 ARTIAH, AMd.Keb Gol. III/ d Rp 4,294,000 42 5 1 47
2 SRI WULAN FITRIJANI Gol. III/ c Rp 3,639,200 36 5 1 41
POLI KULIT KELAMIN

1 MULYONO,S.Kep.Ners Gol. IV/ a Rp 3,953,600 39 5 1 44
2 RIZQI AKSTARIYAH, AMd.Kep Gol. III/ a Rp 2,959,000 29 5 1 34
POLI GIGI
1 MARIATI, A.Md.Kep.Gigi Gol. III/ d Rp 3,793,100 37 5 1 42
2 SRI WAHYUNI Gol. II/ d Rp 2,928,300 29 5 1 34
3 ROSIDA BLUD Rp. 1.003.560/1.926.000 19 2 1 21
4 RIZKA AYU HANDAYANI, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
POLI THT
1 DEDEH KURNIAWATI, S.Kep.Ners Gol. IV/ b Rp 4,811,900 48 5 1 53
2 ELIEK ISBANDIYAH, AMd.Kep Gol. III/ d Rp 3,793,100 37 5 1 42
3 MUTI'AH Gol. II/ c Rp 2,898,000 28 5 1 33
POLI PSIKIATRI

Page 19 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
1 NURADI, AMd.Kep Gol. III/ d Rp 4,294,000 42 5 1 47
2 TANTI ZUSRIFAH Gol. II/ d Rp 2,586,700 25 5 1 30
POLI VCT
1 LULUS HERAWATI (CUTI) Gol. II/ d Rp 3,020,600 30 5 1 35
2 FATIMATU ZUHRO, A.Md.Kep. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
3 LIA CHURNIAWATI, SKM BLUD Rp. 1.585.698/2.456.700 24 1 1 25
INSTALASI REHABILITASI MEDIS

1 ABDUR ROKHIM, A.Md.Fis Gol. III/ d Rp 4,035,800 40 5 1 45
2 MOCHAMAD RIFA'I TANGAHU, A.Md.Fis Gol. III/ b Rp 2,990,000 29 5 1 34
3 ARIS MUNTARTI HARIYANI, A.Md.Fis Gol. III/ b Rp 3,084,200 30 5 1 35
4 RETNO ISTI PALUPI, A.Md.Fis BLUD Rp. 1.662.393/2.192.200 21 5 1 26
5 DWI RATNA JUWITA, A.Md.Fis (Keluar per 1 BLUD Rp. 1.440.741/2.192.200 21 3 1 24
6 VICENTIUS JEPRI PRADONO, A.Md.Fis BLUD Rp. 1.440.741/2.192.200 21 3 1 24
7 RIZQIYANIL ABADIYAH BLUD Rp. 1.304.628/1.926.000 19 3 1 22
8 MUHAMMAD IDRUS ASSEGAF BLUD Rp. 1.341.745/2.456.700 24 2 1 26
9 ELY RACHMAWATI, A.Md BLUD Rp. 1.108.262/2.192.200 21 2 1 23
10 LEILA NUR CAHYA, A.Md.Ft. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
11 NUR FADLILAH, A.Md.Ft. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
UNIT PATOLOGI ANATOMI

1 MULLY KUSUMA WIJAYA, Amd AK Gol. II/ d Rp 2,507,800 25 3 1 28
2 YUSUF BUDIARTO, Amd AK Gol. II/ d Rp 2,507,800 25 3 1 28
3 ANANG NISFU PRADANA, A.Md.AK BLUD Rp. 1.108.262/2.192.200 21 1 1 22
POLI GIZI
1 SULASTRI, A.Md.Gizi Gol. III/ d Rp 3,912,600 39 5 1 44
XV INSTALASI KEDOKTERAN FORENSIK

1 ROCHIM, AMd.Kep Gol. II/ d Rp 2,928,300 29 5 1 34
2 NUR KOLIS Gol. II/ b Rp 2,613,200 26 5 1 31
3 OKA MAHENDRA ADI S., AMd.Kep BLUD Rp. 1.662.393/2.192.200 21 5 1 26
4 MOCH. KHOIRUL IBAD, AMd.Kep BLUD Rp. 1.662.393/2.192.200 21 5 1 26

Page 20 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
5 SULISWANTO BLUD Rp. 1.304.628/1.926.000 19 3 1 22
6 RACHMAT ISMAWAN BLUD Rp. 1.003.560/1.926.000 19 2 1 21
XVI INSTALASI RADIOLOGI

1 SALMAN (CUTI HAJI) Gol. III/ d Rp 3,793,100 37 5 1 42
2 SUYANTO, AMR (CUTI HAJI) Gol. III/ b Rp 2,898,700 28 5 1 33
3 ANANG MA'RUF, AMR Gol. III/ b Rp 3,084,200 30 5 1 35
4 ROSA AMELIA, S.T Gol. III/ b Rp 2,990,000 29 5 1 34
5 WAHYUNI HASTARI Gol. III/ b Rp 3,281,500 32 5 1 37
6 EDY KRISTANTO Gol. III/ a Rp 2,696,200 26 5 1 31
7 CITRA PURNATI PUTRI Gol. III/ a Rp 2,613,800 26 4 1 30
8 LESTARININGSIH H, Amd RD Gol. III/ a Rp 2,613,800 26 4 1 30
9 MUHAMMAD Gol. II/ c Rp 3,083,400 30 5 1 35
10 MOH. SHOLEH Gol. I/ d Rp 2,191,200 21 5 1 26
11 SRI RAHAYU Gol. II/ a Rp 2,667,500 26 5 1 31
12 YULIUS LUSI LABAMAKING, A.Md.Rad. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
13 SAFINAH FAJARINI YUSFADHIYAH BLUD Rp. 1.108.262/2.192.200 21 2 1 23
14 FAHMI HIKAWAN, A.Md.Rad. (Keluar per Me BLUD Rp. 1.108.262/2.192.200 21 1 1 22
XVII LABORATORIUM
1 ASLIKAH Gol. III/ d Rp 4,162,900 41 5 1 46
2 AGUS ANTOYO, S.Si Gol. IV/ a Rp 4,206,000 42 5 1 47
3 AMBAR SULISTIYANI Gol. III/ d Rp 3,565,000 35 5 1 40
4 IMAM SYAFI'I Gol. III/ b Rp 3,181,300 31 5 1 36
5 MOH. TURMUDI Gol. III/ b Rp 3,084,200 30 5 1 35
6 DWI ANGGRAINI Gol. III/ b Rp 3,084,200 30 5 1 35
7 RITNA ERYANTI, Amd.Kes Gol. III/ a Rp 2,959,000 29 5 1 34
8 DHIRA DWI NOVIANTI Gol. III/ a Rp 2,868,700 28 5 1 33
9 CHOTIB, A.Md.Kes Gol. III/ a Rp 2,959,000 29 5 1 34
10 RILA SETIYADI Gol. III/ a Rp 2,959,000 29 5 1 34
11 AKHMAD ABDUL ROKHIM,AMD. Gol. III/ a Rp 2,868,700 28 5 1 33
12 LISTARI RAHAYU Gol. III/ a Rp 2,613,800 26 4 1 30
13 NANANG SIH WIDYANTO Gol. II/ c Rp 3,180,500 31 5 1 36
14 AHMAD JAILANI Gol. II/ a Rp 2,284,400 22 5 1 27

Page 21 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
15 SHOLIHATUN NISWAH D.M, Amd AK (pindah Gol. II/ d Rp 2,507,800 25 4 1 29
16 NIA SUCI NURHAYATI,Amd AK BLUD Rp. 1.662.393/2.192.200 21 5 1 26
17 SRI KANTI APRILIANI BLUD Rp. 1.662.393/2.192.200 21 5 1 26
18 DWI ASTATIEK BLUD Rp. 1.662.393/2.192.200 21 4 1 25
19 ABDUL CHAMID BLUD Rp. 1.662.393/2.192.200 21 4 1 25
20 ARINI NURUL MAR'AH BLUD Rp. 1.440.741/2.192.200 21 2 1 23
21 WULAN BAYU TRISNIAWATY BLUD Rp. 1.440.741/2.192.200 21 2 1 23
22 WAHYU INDRAWANTO, A.Md.AK BLUD Rp. 1.108.262/2.192.200 21 2 1 23
23 DESI DWI MASITHA AMALIA BLUD Rp. 1.108.262/2.192.200 21 2 1 23
24 GERHANA DYAH YUNININGTYAS BLUD Rp. 1.108.262/2.192.200 21 2 1 23
25 CANDRA FIRDANA BLUD Rp. 1.003.560/1.926.000 19 2 1 21
26 DEFAH OCTAVIANI PUTRI, A.Md.AK BLUD Rp. 1.108.262/2.192.200 21 1 1 22
27 LAILATUL PEBRIANTI PUTRI BLUD Rp. 1.108.262/2.192.200 21 1 1 22
UNIT BANK DARAH

1 ESTANU HARTINI, A.Md.AK Gol. III/ c Rp 3,639,200 36 5 1 41
2 NIKMATUS ZUHRIYAH, A.Md.AK BLUD Rp. 1.662.393/2.192.200 21 4 1 25
3 NILLAWATY IRMA SUSANTI, A.Md.AK BLUD Rp. 1.440.741/2.192.200 21 3 1 24
4 CHABIB MARTINO ARIF W, A.Md.AK. BLUD Rp. 1.108.262/2.192.200 21 2 1 23
5 LULUK DINIA RAHMAH, A.Md.AK BLUD Rp. 1.108.262/2.192.200 21 1 1 22
XVIII INSTALASI GIZI

1 ELOK MUMPUNI, S.Gz Gol. IV/ a Rp 4,339,000 43 5 1 48
2 KOENCAHYATI Gol. III/ d Rp 4,294,000 42 5 1 47
3 AINUN JARIYAH, S.Gizi Gol. III/ d Rp 3,912,600 39 5 1 44
4 INDIATI, A.Md.Gizi Gol. III/ d Rp 4,035,800 40 5 1 45
5 SITI MAISYAROH Gol. III/ d Rp 3,677,300 36 5 1 41
6 ENY SUTRIASMI, AMG Gol. III/ d Rp 3,793,100 37 5 1 42
7 ALFU LAILI MAKNUNATIS SA'ADAH Gol. III/ b Rp 2,898,700 28 5 1 33
8 RAHAYU AKHIRITA PANCASARI, AMG Gol. III/ a Rp 2,959,000 29 5 1 34
9 ENDANG SRIKAYATIN Gol. II/ d Rp 3,115,700 31 5 1 36
10 PRATIWI Gol. II/ c Rp 2,723,700 27 5 1 32
11 NUR LATHIFAH Gol. II/ c Rp 2,989,300 29 5 1 34
12 HERNI SUPRAPTI Gol. II/ c Rp 2,989,300 29 5 1 34

Page 22 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
13 ENDANG USWATI Gol. II/ c Rp 2,559,900 25 5 1 30
14 SULIKAH Gol. II/ a Rp 2,284,400 22 5 1 27
15 MUSTAKIM Gol. II/ a Rp 2,284,400 22 5 1 27
16 PANI KUSNAWATI Gol. I/ c Rp 2,283,300 22 5 1 27
17 SRIATUN Gol. I/ c Rp 2,236,800 22 5 1 27
18 MAHMUD FAUZY Gol. I/ c Rp 2,102,300 21 4 1 25
19 ACHMAD HADI SUSANTO Gol. II/ a Rp 2,284,400 22 5 1 27
20 KHOIRUL HUDA Gol. I/ d Rp 2,059,400 20 5 1 25
21 RAHMAT BUDIONO (Keluar 1/8/17) BLUD Rp. 1.505.340/1.926.000 19 4 1 23
22 CHUSNUL CHOTIMAH BLUD Rp. 1.505.340/1.926.000 19 4 1 23
23 EKO MARDIONO BLUD Rp. 1.505.340/1.926.000 19 5 1 24
24 OKTAVIA DEWI BLUD Rp. 1.505.340/1.926.000 19 5 1 24
25 SUBAGIYO BLUD Rp. 1.505.340/1.926.000 19 5 1 24
26 BUDI SUCAHYO BLUD Rp. 1.505.340/1.926.000 19 4 1 23
27 LYNA TAURISIA BLUD Rp. 1.505.340/1.926.000 19 4 1 23
28 M. YUSUF AZHARI BLUD Rp. 1.505.340/1.926.000 19 4 1 23
29 SRI RAHAYU BLUD Rp. 1.505.340/1.926.000 19 4 1 23
30 DEWI SRI WAHYUNI BLUD Rp. 1.440.741/2.192.200 21 3 1 24
31 AMINATUS SHOLIKHA (CUTI) BLUD Rp. 1.304.628/1.926.000 19 3 1 22
32 HENDRESTU PUTRANI SUMARJI BLUD Rp. 1.304.628/1.926.000 19 3 1 22
33 ONKY KURNIAWAN BLUD Rp. 1.003.560/1.926.000 19 2 1 21
34 DWI AJI SRIANINGRUM (CUTI) BLUD Rp. 1.829.652/2.456.700 24 2 1 26
35 LIA NURYANTI BLUD Rp. 1.440.741/2.192.200 21 2 1 23
36 AGUS BUDI SUSANTO BLUD Rp. 1.505.340/1.926.000 19 5 1 24
37 EKA PUTRI ZULFATIN, A.Md.Gz BLUD Rp. 1.440.741/2.192.200 21 1 1 22
38 NAILA RISKA ARINITAMI, A.Md.Gz BLUD Rp. 1.440.741/2.192.200 21 1 1 22
39 SR WIDYA ARETA HUMANIORA JUSTISIA, BLUD Rp. 1.440.741/2.192.200 21 1 1 22
XIX I P S
1 ROFIK UDIN, S.ST Gol. III/ b Rp 2,898,700 28 5 1 33
2 SUNTONO Gol. II/ c Rp 2,640,600 26 5 1 31
3 YUDY KURNIAWAN Gol. II/ c Rp 2,559,900 25 5 1 30
4 A. SYAIFUL Gol. II/ c Rp 2,559,900 25 5 1 30
5 SELAMET RIADI Gol. I/ c Rp 1,975,800 19 5 1 24

Page 23 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
6 FARIED DWI KURNIAWAN Gol. II/ d Rp 2,507,800 25 3 1 28
7 DWI WIDYANINGSTYAS Gol. II/ d Rp 2,507,800 25 3 1 28
8 EFANA Gol. II/ d Rp 2,507,800 25 4 1 29
9 IMAM SAMUDI BLUD Rp. 1.662.393/2.192.200 21 4 1 25
10 SUPARDI BLUD Rp. 1.304.628/1.926.000 19 3 1 22
11 ADE MAULIDIANTA KRISNA, A.Md. BLUD Rp. 1.662.393/2.192.200 21 3 1 24
12 DEWI RUSHALINA BLUD Rp. 1.440.741/2.192.200 21 3 1 24
13 NASRO KARIM BLUD Rp. 1.003.560/1.926.000 19 2 1 21
14 M. YASIR ARDIYANSYAH BLUD Rp. 1.003.560/1.926.000 19 2 1 21
15 SEVRIA PARAMITA, A.Md.TEM. (CUTI) BLUD Rp. 1.108.262/2.192.200 21 2 1 23
16 BAGUS NARENDRA PUTRA MAHFUT BLUD Rp. 1.003.560/1.926.000 19 1 1 20
17 HADI AKHMAD SULTON BLUD Rp. 1.003.560/1.926.000 19 1 1 20
18 MASYHADI IRFAN BLUD Rp. 1.003.560/1.926.000 19 1 1 20
19 KHOINNADIF BLUD Rp. 1.003.560/1.926.000 19 1 1 20
20 ASTU CAHYO NUGROHO, A.Md.TEM BLUD Rp. 1.440.741/2.192.200 21 1 1 22
21 PUTRI LARAS SARI, A.Md.TEM BLUD Rp. 1.440.741/2.192.200 21 1 1 22
XX I PL
1 HARI PRIONO Gol. III/ d Rp 4,035,800 40 5 1 45
2 MOCH. BACHRUL ARIFIN Gol. IV/ a Rp 4,206,500 42 5 1 47
3 PANCA WATININGSIH, ST Gol. III/ d Rp 3,350,600 33 5 1 38
4 YULIUS RIBIYATI, SKM Gol. III/ b Rp 2,898,700 28 5 1 33
5 SUBECHAN Gol. II/ d Rp 3,213,800 32 5 1 37
6 SUPARTO Gol. II/ c Rp 2,640,600 26 5 1 31
7 SAMTO Gol. II/ c Rp 2,723,700 27 5 1 32
8 MOHAMAD TOHA Gol. II/ a Rp 2,586,100 25 5 1 30
9 SARONI Gol. II/ a Rp 2,214,700 22 5 1 27
10 MULYONO Gol. I/ c Rp 2,236,800 22 5 1 27
11 SUNANIK Gol. I/ c Rp 1,975,800 19 5 1 24
12 AHYAD Gol. I/ d Rp 2,059,400 20 5 1 25
13 APRILIA KRISTIANI BLUD Rp. 1.505.340/1.926.000 19 5 1 24
14 VITA ARI WIDIANTI BLUD Rp. 1.505.340/1.926.000 19 5 1 24
15 RETNO ISWARI Gol. II/ c Rp 2,989,300 29 5 1 34
16 SAMIN Gol. I/ c Rp 2,307,200 23 5 1 28

Page 24 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
17 SUKADI Gol. II/ c Rp 2,640,600 26 5 1 31
18 SUNARTO Gol. I/ d Rp 2,191,200 21 5 1 26
19 ANGGUN SRI REJEKI, AMd.KL BLUD Rp. 1.440.741/2.192.200 21 1 1 22
20 RATNA DEWI LAILATUL ALMUFIDAH, AMd BLUD Rp. 1.440.741/2.192.200 21 1 1 22
21 RIZAL BAHRI, AMd.KL BLUD Rp. 1.440.741/2.192.200 21 1 1 22
XXI INSTALASI FARMASI

1 ALIA NEFRIYANA,S Si. Apt Gol. IV/ a Rp 3,492,400 34 5 1 39
2 SANI Gol. III/ d Rp 4,162,900 41 5 1 46
3 ENY POEDJIATI Gol. III/ d Rp 3,793,100 37 5 1 42
4 ANIS THOHIROH,S.Farm-Klin,Apt Gol. III/ d Rp 3,053,000 30 4 1 34
5 YUSRON ANSHORI,S.Far,Apt Gol. III/ d Rp 3,053,000 30 4 1 34
6 PRASETYO TUNGGONO Gol. III/ d Rp 3,565,000 35 5 1 40
7 JUMAIYAH SRI NINGSIH Gol. III/ c Rp 3,315,900 33 5 1 38
8 SUSANTI Gol. III/ c Rp 3,315,900 33 5 1 38
9 ROSTIANY NOVAIDA Gol. III/ b Rp 2,990,000 29 5 1 34
10 UMU KHOIROH Gol. III/ a Rp 2,959,000 29 5 1 34
11 SUMIATI Gol. II/ d Rp 2,586,700 25 5 1 30
12 REKNA SARY KHOIRIYA Gol. II/ d Rp 2,752,300 27 5 1 32
13 HAMIDAH KUSNAWATI Gol. II/ d Rp 2,752,300 27 5 1 32
14 NUR INDAH FATMAWATI Gol. II/ d Rp 2,507,800 25 5 1 30
15 ENNY NURAHMAWATI Gol. II/ d Rp 2,668,200 26 5 1 31
16 LATHIFAH CHULQIN Gol. II/ d Rp 2,668,200 26 5 1 31
17 MOCH.BAMBANG SETIAWAN Gol. II/ d Rp 2,668,200 26 5 1 31
18 ROHMAWATI Gol. II/ c Rp 2,559,900 25 5 1 30
19 IDA RIJANI Gol. II/ c Rp 2,559,900 25 5 1 30
20 NAWIRIN Gol. II/ c Rp 2,640,600 26 5 1 31
21 ANIK PUJI ASTUTI Gol. II/ b Rp 2,456,000 24 5 1 29
22 DYAH RINI SRI KUSUMAWATI Gol. II/ b Rp 2,456,000 24 5 1 29
23 EKA ANIK WIJAYANTI Gol. II/ b Rp 2,456,000 24 5 1 29
24 HARI SETYA WIYANDARI Gol. II/ b Rp 2,456,000 24 5 1 29
25 NURMA ANDRI HASTUTIK Gol. II/ d Rp 2,507,800 25 4 1 29
26 FRANSISCA NIKEN ANGGRAENI Gol. II/ d Rp 2,507,800 25 4 1 29
27 SYARIFATUZ ZAHROH Gol. II/ d Rp 2,507,800 25 4 1 29

Page 25 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
28 IMRO'ATUL AZIZAH Gol. II/ d Rp 2,507,800 25 4 1 29
29 SANTOSO Gol. II/ a Rp 2,284,400 22 5 1 27
30 NURUL KISWORO Gol. II/ b Rp 2,381,100 23 5 1 28
31 WIDYA SHOLIHATUL N,S.Si Apt BLUD Rp. 1.829.652/2.456.700 24 5 1 29
32 TITIN ROSNAWATI, S.Farm. Apt BLUD Rp. 1.829.652/2.456.700 24 5 1 29
33 AINI HANIFAH BLUD Rp. 1.662.393/2.192.200 21 4 1 25
34 NORMALINDA KHOIROTIN BLUD Rp. 1.662.393/2.192.200 21 4 1 25
35 WAHYUDI BLUD Rp. 1.505.340/1.926.000 19 5 1 24
36 CAHAYA ELIDA AFNI BLUD Rp. 1.505.340/1.926.000 19 5 1 24
37 NUR ANISAUS SHOLIHA BLUD Rp. 1.505.340/1.926.000 19 5 1 24
38 IZZATI ROMIDAH, A.Md.Farm BLUD Rp. 1.662.393/2.192.200 21 4 1 25
39 ERIEK EKO PRABOWO BLUD Rp. 1.304.628/1.926.000 19 3 1 22
40 EKA KURNIAWATI BLUD Rp. 1.304.628/1.926.000 19 3 1 22
41 SITI NURSAIDAH BLUD Rp. 1.304.628/1.926.000 19 3 1 22
42 ISWATI KHASANAH BLUD Rp. 1.304.628/1.926.000 19 3 1 22
43 SRI WULAN MARTINING R. BLUD Rp. 1.304.628/1.926.000 19 3 1 22
44 SITI NUR AISYAH, S.Farm-Klin, Apt BLUD Rp.3.000.000/2.560.600 25 2 1 27
45 SITI FAIRUZ, S.Farm. Apt BLUD Rp. 1.829.652/2.456.700 24 2 1 26
46 VENY FIRDAUZI, S.Farm. Apt BLUD Rp. 1.829.652/2.456.700 24 2 1 26
47 NIFDA NOVI ARIYANI, S.Farm. Apt BLUD Rp. 1.829.652/2.456.700 24 1 1 25
48 AISYAH ASMI, S.Farm, Apt BLUD Rp. 1.829.652/2.456.700 24 1 1 25
49 FAUZA TAQIYYA, S.Farm, Apt. BLUD Rp. 1.829.652/2.456.700 24 1 1 25
50 FADHILATUR ROHMAH, A.Md.Farm. BLUD Rp. 1.108.262/2.192.200 21 4 1 25
51 NUR KHOLIFAH, A.Md.Farm. BLUD Rp. 1.108.262/2.192.200 21 4 1 25
XXII UNIT P D E
1 DWI SETYAWAN Gol. III/ c Rp 3,214,700 32 5 1 37
2 ARIFUDIN Gol. III/ a Rp 2,959,000 29 5 1 34
3 RACHMAWATI Gol. III/ a Rp 2,868,700 28 5 1 33
4 HERLIN RIYANTI PRANA NINGRUM (CUTI) Gol. II/ b Rp 2,456,000 24 5 1 29
5 DYAH IKA SETYA WINARNI Gol. II/ b Rp 2,456,000 24 5 1 29
6 TUTIK ULFIAH Gol. II/ b Rp 2,456,000 24 5 1 29
7 ARIEF YULHAM EFENDI,Amd Gol. II/ d Rp 2,507,800 25 3 1 28
8 SITI NINGSIH Gol. II/ c Rp 2,989,300 29 5 1 34

Page 26 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
9 ACHMAD RIVANTO Gol. II/ b Rp 2,456,000 24 5 1 29
10 WAHYU EKA PERDANA BLUD Rp. 1.829.652/2.456.700 24 5 1 29
11 ACH. FANY USMAN BLUD Rp. 1.505.340/1.926.000 19 5 1 24
12 BAMBANG SUPRAYOGI, A.Md BLUD Rp. 1.108.262/2.192.200 21 2 1 23
13 SETIAWAN, A.Md BLUD Rp. 1.219.088/2.192.200 21 2 1 23
14 PRINA PRIYATNA PUTRI, S.Si BLUD Rp. 1.219.768/2.456.700 24 2 1 26
15 MUH. ALIEF SAPTA RAMADHANI BLUD Rp. 1.108.262/2.192.200 21 2 1 23
16 HARDIAN ERIK KRISTANTI,S.Kom BLUD Rp. 1.585.698/2.456.700 24 3 1 27
XXIII UNIT K3RS

1 SAIKHUNUDDIN, SKM (CUTI HAJI) Gol. III/ a Rp 2,868,700 28 5 1 33
2 RAHMATULLAH, S.ST Gol. III/ d Rp 4,035,800 40 5 1 45
3 ANGGAWA RIZKY PUTRA RAHARDANA, A BLUD Rp. 1.108.262/2.192.200 21 2 1 23
XXIV SOPIR AMBULANCE

1 GAGUK TALLY SUSANTO Gol. III /b Rp 3,491,500 34 5 1 39
2 EKO PURWANTO Gol. II/ c Rp 2,898,000 28 5 1 33
3 EDY SLAMETO Gol. II/ c Rp 2,898,000 28 3 1 31
4 AGUNG PRATIKTO Gol. II/ c Rp 2,723,700 27 5 1 32
5 EDY MUTTAQIN Gol. II/ c Rp 2,723,700 27 5 1 32
6 HERRY SUHARTONO Gol. II/ c Rp 2,481,800 24 5 1 29
7 ACH. BAIDLOWI Gol. II/ b Rp 2,456,000 24 5 1 29
8 SUTAJI BLUD Rp. 964.642/1.692100 16 2 1 18
PORTER
1 ANDI ROHMAN Gol. II/ c Rp 2,640,600 26 5 1 31
2 A.ALWI Gol. II/ a Rp 2,284,400 22 5 1 27
3 RELASNO Gol. I/ c Rp 2,038,100 20 5 1 25
4 MUHAMMAD ABDUL ROHMAN Gol. I/ c Rp 1,915,500 19 5 1 24
XXV SATPAM
1 SUTOYO ARIEF Gol. II/ c Rp 2,640,600 26 5 1 31
2 SULISTRIONO Gol. III/ b Rp 3,384,900 33 5 1 38
3 AGUS SUBANDI, SH Gol. III/ a Rp 3,349,800 33 5 1 38

Page 27 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
4 DIDIEK HARTONO Gol. II/ c Rp 2,640,600 26 5 1 31
5 ALFI KHAMDAN Gol. II/ c Rp 2,640,600 26 5 1 31
6 R. SAIDUS SALIM Gol. II/ c Rp 2,640,600 26 5 1 31
7 KUSNADI Gol. II/ c Rp 2,809,500 28 4 1 32
8 SISWANTO Gol. II/ c Rp 2,809,500 28 4 1 32
9 MAT SOLEH Gol. II/ a Rp 2,284,400 22 5 1 27
10 MUHAMMAD AMIN ROSYADI Gol. II/ c Rp 2,559,900 25 5 1 30
11 ANGGA EKA PURNAMA, SE BLUD Rp. 1.829.652/2.456.700 24 5 1 29
12 SALMAN AL FARISIN BLUD Rp. 1.505.340/1.926.000 19 5 1 24
13 SANGGA FAJAR BLUD Rp. 1.505.340/1.926.000 19 5 1 24
14 EDI WAHYU PRIYANTO BLUD Rp. 1.304.628/1.926.000 19 3 1 22
15 TRIONO HARI PRAYOGO BLUD Rp. 1.304.628/1.926.000 19 3 1 22
16 TONY JUNIAR SUJATMIKO, SE BLUD Rp. 1.829.652/2.456.700 24 3 1 27
17 MUHAMMAD MUNIF BLUD Rp. 1.304.628/1.926.000 19 3 1 22
18 MOCH. SEPTIAWAN I. C. BLUD Rp. 1.304.628/1.926.000 19 3 1 22
19 SUGIHARNO BLUD Rp. 1.304.628/1.926.000 19 3 1 22
XXVI STAF KOMITE MEDIK

1 ROSYIDATUL AINI BLUD Rp. 1.304.628/1.926.000 19 3 1 22
2 HANIK AMANAH BLUD Rp. 1.446.963/1.692100 16 5 1 21
XXVII KELOMPOK MEDIS

1 dr. YANUAR SYAM, Sp B Gol. IV/ d Rp 5,227,600 52 5 1 57
2 drg. PATRICIA SORAYA I Gol. IV/ c Rp 5,173,400 51 5 1 56
3 dr. TITIK DYAH WIDOWATI, MARS Gol. IV/ c Rp 4,713,800 47 5 1 52
4 dr. YULIA TASNIM Gol. IV/ c Rp 4,862,300 48 3 1 51
5 drg. SANDRA VIANE IH Gol. IV/ c Rp 4,862,300 48 4 1 52
6 dr. BAMBANG TUHARIYANTO,SpM Gol. IV/ d Rp 5,068,000 50 5 1 55
7 dr. MULIAWAN Q.P, Sp S Gol. IV/ d Rp 5,068,000 50 5 1 55
8 dr. CAECILIA F.L, Sp P Gol. IV/ d Rp 5,068,000 50 5 1 55
9 dr. SAFITRI ANDRIANA,Sp PA Gol. IV/ b Rp 4,665,000 46 5 1 51
10 dr. HIDAYAT WIRIANTONO,SP GK Gol. IV/ c Rp 4,862,300 48 5 1 53
11 dr. ROCHMAD YASIN, Sp U Gol. IV/ c Rp 4,862,300 48 5 1 53
12 dr. FREDRIEK MANALU,Sp.Rad Gol. IV/ c Rp 4,713,800 47 3 1 50

Page 28 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
13 drg. FINA BINAWATI Gol. IV/ c Rp 4,569,900 45 5 1 50
14 dr. WIND FAIDATI, Sp KK Gol. IV/ c Rp 4,862,300 48 5 1 53
15 drg. ANDRY ANDYASASSI, Sp Orto Gol. IV/ c Rp 4,430,400 44 4 1 48
16 dr. SRI RAHAYU, M.Kes Gol. IV/ b Rp 4,552,500 45 3 1 48
17 dr. ZAINUL ARIFIN, Sp OG Gol. IV/ b Rp 4,250,600 42 5 1 47
18 dr. SRI WAHYUNINGSIH, Sp R Gol. IV/ b Rp 4,665,000 46 5 1 51
19 dr. POEDJO ASTOTIE Gol. IV/ a Rp 3,953,600 39 5 1 44
20 dr. ZAYNUL ARIFIN , Sp OT Gol. IV/ b Rp 4,250,600 42 4 1 46
21 dr. HERRY SUPRIYANTO, Sp JP Gol. III/ d Rp 4,162,900 41 5 1 46
22 dr. MUHAMMAD RUSYDI Gol. IV/ a Rp 3,602,400 36 5 1 41
23 dr. KARTIKO H ODI,Sp THT Gol. III/ d Rp 3,149,100 31 4 1 35
24 dr. MAS'ADAH (TUBEL) Gol. III/ d Rp 3,149,100 31 3 1 34
25 dr. ISKANDAR, Sp.PD Gol. IV/ a Rp 4,616,600 46 3 1 49
26 dr. HILMAN MAYANTANA Gol. III/ c Rp 2,929,100 29 3 1 32
27 dr. FERRY A SUMIRAT,Msc.,SpA Gol. III/ d Rp 3,053,000 30 3 1 33
28 dr. DIAH ERNAWATI,SpS Gol. III/ d Rp 3,053,000 30 3 1 33
29 dr. WIWIK KURNIA ILAHI,Sp.P Gol. III/ b Rp 2,810,200 28 3 1 31
30 dr. IRMA WESPRIMAWATI,SpPD Gol. III/ b Rp 2,990,000 29 3 1 32
31 dr. DESY ARHADINANTIYAS Gol. IV/ a Rp 3,492,400 34 3 1 37
32 dr. KIKI DICKY TAMPUBOLON, SpAn Gol. III/ b Rp 2,641,200 26 2 1 28
33 dr. ACHMADI, SpOG Gol. III/ c Rp 2,449,300 24 2 1 26
34 dr. HARI PURNOMO, Sp.THT Gol. IV/ c Rp 4,862,300 48 2 1 50
35 dr. TRI RACHMADIJANTO, SpA Gol. III/ d Rp 3,793,100 37 2 1 39
36 dr. KURNIATI, SpKK Gol. III/ b Rp 2,810,200 28 2 1 30
37 dr. LISA PUSPITORINI, SpS Gol. III/ b Rp 2,810,200 28 2 1 30
38 dr. KRISNA HARDYAWAN, SpAn Gol. III/ b Rp 2,724,400 27 2 1 29
39 dr. RUBY ARDHANA BLUD Rp.2.640.000/2.560.600 25 3 1 28
40 dr. LUSIANA KUSUMAWARDANI, SpJP FIH Gol. III/ b Rp 2,898,700 28 2 1 30
41 dr. SUJIANTO, SpPK Gol. IV/ b Rp 4,665,000 46 2 1 48
42 dr. IMAMA QOSIDA, Sp.M Gol. III/ c Rp 2,929,100 29 2 1 31
43 dr. R.M.DAVID JAYANEGARA, SpOT Gol. III/ b Rp 2,641,200 26 2 1 28
44 dr. WIWIEKA MERBAWANI, SpA Gol. III/ d Rp 3,565,000 35 2 1 37
45 dr. YULIANA ARISANTI, SpOG Gol. III/ c Rp 2,839,700 28 2 1 30
46 dr. NYIMAS MAIDA S, SpPD Gol. III/ b Rp 2,641,200 26 2 1 28

Page 29 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
47 drg. CHITRA RIZKITASARI, SpKG Gol. III/ b Rp 2,641,200 26 2 1 28
48 dr. TAUFAN HARIJANTO, SpB-KBD BLUD Rp.3.000.000/2.560.600 25 2 1 27
49 dr. MUHAMMAD LUTHFI AZIZI (Keluar 1/8/ BLUD Rp.2.400.000/2.560.600 25 2 1 27
50 drg. ALFA KURNIASANTHY, SpKG Gol. III/ d Rp 3,248,300 32 2 1 34
51 dr. ARIF FAKHRUDIN, SpA Gol. III/ c Rp 3,116,500 31 2 1 33
52 dr. ACHMAD NURDIN, SpP BLUD Rp.3.000.000/2.560.600 25 2 1 27
53 dr. DONO MARSETIO WIBISONO, SpB BLUD Rp.3.000.000/2.560.600 25 2 1 27
54 dr. RACHFITA CHANDRA GRESIYANA DEWI BLUD Rp.3.000.000/2.560.600 25 2 1 27
55 dr. RISTY ARIE HARDINI, Sp.M BLUD Rp.3.000.000/2.560.600 25 2 1 27
56 dr. MUHAMMAD AINUL HUDA, SpBS BLUD Rp.3.000.000/2.560.600 25 2 1 27
57 dr. EKA FAFA SURYANDARI BLUD Rp.2.400.000/2.560.600 25 2 1 27
58 dr. SARI HANDAYANI K, Sp RM BLUD Rp.3.000.000/2.560.600 25 2 1 27
59 dr. AHYAR HARABITI BLUD Rp.2.400.000/2.560.600 25 2 1 27
60 dr. MUHAMMAD ATABIK BLUD Rp.2.400.000/2.560.600 25 2 1 27
61 dr. CHAIRUR RIJAL AGUS WICAKSONO BLUD Rp.2.400.000/2.560.600 25 2 1 27
62 dr. ANDI INSYAFRIANTO BLUD Rp.2.400.000/2.560.600 25 2 1 27
63 dr. WIDIAH INDRA ARSANTI (Keluar 1/9/17 BLUD Rp.2.400.000/2.560.600 25 2 1 27
64 dr. H. SOEROTO HADISOEMARTO, Sp.F(K BLUD Rp.3.000.000/2.560.600 25 2 1 27
65 dr. RUDYANTO DWI A, Sp PD Gol. IV/ a Rp 3,715,800 37 2 1 39
66 dr. HARIANAH, Sp PK Gol. III/ d Rp 3,350,600 33 2 1 35
67 dr. RUSDIYANA EKAWATI, SpPD (ENDOS) BLUD Rp.3.000.000/2.560.600 25 2 1 27
68 dr. MEFI WINDIASTUTI,Sp KJ Gol. IV/ a Rp 3,715,800 37 2 1 39
69 dr. ENDRI WIJANARKO, SpAn BLUD Rp.3.000.000/2.560.600 25 2 1 27
70 dr. ARI WAHYU KUSDIANA, SpOG BLUD Rp.3.000.000/2.560.600 25 2 1 27
71 dr. RERYD ARINDANY WIRYAWAN BLUD Rp.2.400.000/2.560.600 25 2 1 27
72 dr. RINA SIAMA RAHMAWATI Gol. IV/ a Rp 3,385,700 33 2 1 35
73 dr. DIANA MAZAYA ATSARINA (baru 1/3/17) BLUD Rp.2.400.000/2.560.600 25 1 1 26
74 dr. SETYO ARI CAHYONO (baru 1/3/17) BLUD Rp.2.400.000/2.560.600 25 1 1 26
75 dr. AGUNG KUSUMANEGARA, SpB (baru 13/3/17)
BLUD Rp.3.000.000/2.560.600 25 1 1 26
76 dr. AGUNG PRASETYO, SpPD (baru 1/4/17) BLUD Rp.3.000.000/2.560.600 25 1 1 26
77 dr. MUHAMMAD ABDUL ROZAQ (baru 1/8/1 BLUD Rp.2.400.000/2.560.600 25 1 1 26
78 dr. DEVITA PRIMA NURMASARI (baru 1/8/1 BLUD Rp.2.400.000/2.560.600 25 1 1 26
79 dr. ALFINA HADID FERDIANSYAH (baru 1/8 BLUD Rp.2.400.000/2.560.600 25 1 1 26
80 dr. ENDANG P Gol. IV/ c

Page 30 of 248
GOL JUMLAH N MK B S
BASIC INDEX (1)
81 SMF SPD Gol. III/ b
LAIN - LAIN
1 FEE CITO PETUGAS O K
2 FEE CITO PETUGAS ANASTESI
3 ADM VIP IRJA BL. AGUSTUS '17
JUMLAH
Plt Kabag Rengram

Selaku Pengguna Kuasa Anggaran
Akhmad Munif, S.Sos

NIP. 19630616 198712 1 001
1 BPJS JULI 2017 925,771,569.00 925,771

2 TB MDR SEPTEMBER 2017 5,241,057.50 5,241

Page 31 of 248
NERASI PEGAWAI RSUD IBNU SINA KAB. GRESIK, BULAN : SEPTEMBE
PENDIDIKAN SERTIFIKAT RESIKO KERJA KEDARURATAN KERJA JABAT

YANG DIAKUI N YANG DIMILIKI N Total B S TEMPAT N B S TEMPAT N B S STRUKTURAL
CAPACITY INDEX (2) RISK INDEX (3) EMERGENCY INDEX (4) POSITI
5 6 7
Dokter Spes 8 LPJ + Diklat 1.6 9.6 2 19.2 Manj. 1 3 3 Manj. 1 3 3 Direktur
S1 Dokter 7 LPJ + Diklat 2.2 9.2 2 18.4 Manj. 1 3 3 Manj. 1 3 3 Wadir Me
S1 Kep Ners 7 LPJ + Diklat 3.4 10.4 2 20.8 Manj. 1 3 3 Manj. 1 3 3 Wadir Umum
S2 Mag.Sain 8 LPJ + Diklat 3.4 11.4 2 22.8 Manj. 1 3 3 Manj. 1 3 3 Kabag T.

S1 Hukum 6 LPJ + Diklat 1.6 7.6 2 15.2 Manj. 1 3 3 Manj. 1 3 3 KaSubag Umum &
S1 Kep Ners 7 LPJ + Diklat 2.2 9.2 2 18.4 Manj. 1 3 3 Manj. 1 3 3 KaSubag PS
S1 Ekonomi 6 LPJ + Diklat 1.4 7.4 2 14.8 Manj. 1 3 3 Manj. 1 3 3 KaSubag Pers
S1 Ekonomi 6 LPJ + Diklat 1.4 7.4 2 14.8 Manj. 1 3 3 Manj. 1 3 3 Anggota PP
S1 Ekonomi 6 LPJ + Diklat 1 7.0 2 14 Manj. 1 3 3 Manj. 1 3 3 Pemeriksa B
S1 Kes Mas 6 LPJ + Diklat 1 7.0 2 14 Manj. 1 3 3 Manj. 1 3 3 Anggota Peng
S1 Ekonomi 6 LPJ + Diklat 1.2 7.2 2 14.4 Manj. 1 3 3 Manj. 1 3 3 Staf
SLTA 3 LPJ + Diklat 1.6 4.6 2 9.2 Manj. 1 3 3 Manj. 1 3 3 Staf
SMKK 3 LPJ + Diklat 1 4.0 2 8 Manj. 1 3 3 Manj. 1 3 3 Staf
STM 3 LPJ + Diklat 1.2 4.2 2 8.4 Manj. 1 3 3 Manj. 1 3 3 Staf
SLTA 3 LPJ + Diklat 1.6 4.6 2 9.2 Manj. 1 3 3 Manj. 1 3 3 Pembantu Pengur
SLTA 3 LPJ + Diklat 0.8 3.8 2 7.6 Manj 1 3 3 Manj. 1 3 3 Staf
SLTP 2 LPJ + Diklat 1.4 3.4 2 6.8 Manj. 1 3 3 Manj. 1 3 3 Pemeriksa B
S1 Ekonomi 6 Diklat 0.4 6.4 2 12.8 Manj. 1 3 3 Manj. 1 3 3 Staf
S1 Teknik 6 Diklat 0.2 6.2 2 12.4 Manj. 1 3 3 Manj. 1 3 3 Staf
S1 Teknik 6 Diklat 0.4 6.4 2 12.8 Manj. 1 3 3 Manj. 1 3 3 Anggota PP
SLTA 3 Diklat 0.6 3.6 2 7.2 Manj. 1 3 3 Manj. 1 3 3 Anggota PP
S1 Hukum 6 Diklat 0.2 6.2 2 12.4 Manj. 1 3 3 Manj. 1 3 3 Staf
S1 Komunikasi 6 Diklat 0.4 6.4 2 12.8 Manj. 1 3 3 Manj. 1 3 3 Staf
SMP 2 Diklat 0.2 2.2 2 4.4 Manj. 1 3 3 Manj. 1 3 3 Staf
S1 Kes Mas 6 Diklat 0.4 6.4 2 12.8 Manj. 1 3 3 Manj. 1 3 3 Staf
SMA 3 Diklat 0.2 3.2 2 6.4 Manj. 1 3 3 Manj. 1 3 3 Staf
S1 Ekonomi 6 0 6.0 2 12 Manj. 1 3 3 Manj. 1 3 3 Staf

Page 32 of 248

S1 Tehnik Sipil 6 Diklat 0.2 6.2 2 12.4 Manj. 1 3 3 Manj. 1 3 3 Anggota PP
S1 Ekonomi Islam 6 0 6.0 2 12 Manj. 1 3 3 Manj. 1 3 3 Staf
S2 Akuntansi 8 LPJ + Diklat 1.4 9.4 2 18.8 Manj. 1 3 3 Manj. 1 3 3 Kabag Keua
S2 Akuntansi 8 LPJ + Diklat 2.8 10.8 2 21.6 Manj. 1 3 3 Manj. 1 3 3 Kasubid Ver &
S2 Mag.Kes 8 LPJ + Diklat 2.2 10.2 2 20.4 Manj. 1 3 3 Manj. 1 3 3 Kasubag Aku
SLTA 3 LPJ + Diklat 1.2 4.2 2 8.4 Manj. 1 3 3 Manj. 1 3 3 Bend. Penge
S2 Administrasi 8 LPJ + Diklat 1.2 9.2 2 18.4 Manj. 1 3 3 Manj. 1 3 3 Sek. Pengadaan
S1 Ekonomi 6 LPJ + Diklat 0.8 6.8 2 13.6 Manj. 1 3 3 Manj. 1 3 3 Pembantu Bend. P
S1 Ekonomi 6 LPJ + Diklat 0.8 6.8 2 13.6 Manj. 1 3 3 Manj. 1 3 3 Bend. Peneri
S1 Ekonomi 6 LPJ + Diklat 1 7.0 2 14 Manj. 1 3 3 Manj. 1 3 3 Pembantu P
D3 Akuntansi 5 LPJ + Diklat 0.8 5.8 2 11.6 Manj. 1 3 3 Manj. 1 3 3 Pembantu Ben
D3 Akuntansi 5 LPJ + Diklat 0.8 5.8 2 11.6 Manj. 2 3 6 Manj. 2 3 6 Staf
D3 Perbankan 5 LPJ + Diklat 0.8 5.8 2 11.6 Manj. 1 3 3 Manj. 1 3 3 Staf
SLTA 3 LPJ + Diklat 0.8 3.8 2 7.6 Manj. 1 3 3 Manj. 1 3 3 Pembantu Bend.
SLTA 3 LPJ + Diklat 1 4.0 2 8 Manj. 1 3 3 Manj. 1 3 3 Staf
SMK 3 LPJ + Diklat 0.8 3.8 2 7.6 Manj. 1 3 3 Manj. 1 3 3 Staf
SLTA 3 LPJ + Diklat 0.8 3.8 2 7.6 Manj. 1 3 3 Manj. 1 3 3 Pembantu P
S1 Ekonomi 6 Diklat 0.2 6.2 2 12.4 Manj. 1 3 3 Manj. 1 3 3 Penunjang Pemb
S1 Sosial 6 Diklat 0.2 6.2 2 12.4 Manj. 1 3 3 Manj. 1 3 3 Staf
D3 Akuntansi 5 Diklat 0.2 5.2 2 10.4 Manj. 2 3 6 Manj. 2 3 6 Staf
S1 Sosial 6 Diklat 0.6 6.6 2 13.2 Manj. 1 3 3 Manj. 1 3 3 STAF
S1 Pend 6 Diklat 0.2 6.2 2 12.4 Manj. 2 3 6 Manj. 2 3 6 Staf
S1 Pend 6 Diklat 0.2 6.2 2 12.4 Manj. 1 3 3 Manj. 1 3 3 Staf

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S2 Manj. 8 LPJ + Diklat 1.6 9.6 2 19.2 Manj. 1 3 3 Manj. 1 3 3 Ka Bid Reng
S1 Sosial 6 LPJ + Diklat 3.4 9.4 2 18.8 Manj. 1 3 3 Manj. 1 3 3 Kasubag Sun
S1 Kes. Masy 6 LPJ + Diklat 3.8 9.8 2 19.6 Manj. 1 3 3 Manj. 1 3 3 Kasubag R
D3 Rekam Medis 5 LPJ + Diklat 1 6.0 2 12 Manj. 1 3 3 Manj. 1 3 3 Staf
SLTA 3 LPJ + Diklat 1 4.0 2 8 Manj. 1 3 3 Manj. 1 3 3 Pemeriksa B
D3 Tehnik ling 5 LPJ + Diklat 1.4 6.4 2 12.8 Manj. 1 3 3 Manj. 1 3 3 Anggota Pengad
SLTA 3 LPJ + Diklat 1 4.0 2 8 Manj. 1 3 3 Manj. 1 3 3 Anggota PP
SMEA 3 LPJ + Diklat 1 4.0 2 8 Manj. 1 3 3 Manj. 1 3 3 Staf
SMEA 3 LPJ + Diklat 1 4.0 2 8 Manj. 1 3 3 Manj. 1 3 3 Staf
SLTP 2 LPJ + Diklat 1 3.0 2 6 Manj. 2 3 6 Manj. 2 3 6 Staf
D3 Rekam Medis 5 LPJ + Diklat 1 6.0 2 12 Manj. 1 3 3 Manj. 1 3 3 Staf
D3 Rekam Medis 5 LPJ + Diklat 0.8 5.8 2 11.6 Manj. 2 3 6 Manj. 1 3 3 Staf
SLTA 3 LPJ + Diklat 1.2 4.2 2 8.4 Manj. 1 3 3 Manj. 1 3 3 Anggota PP
D3 Rekam Medis 5 Diklat 0.2 5.2 2 10.4 Manj. 1 3 3 Manj. 1 3 3 Staf
SLTA 3 Diklat 0.6 3.6 2 7.2 Manj. 1 3 3 Manj. 1 3 3 Anggota PP
SLTA 3 Diklat 0.4 3.4 2 6.8 Manj. 2 3 6 Manj. 2 3 6 Staf
D1 Komputer 3 Diklat 0.2 3.2 2 6.4 Manj. 2 3 6 Manj. 1 3 3 Staf

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S1 Sosial 6 LPJ + Diklat 0.8 6.8 2 13.6 Manj. 2 3 6 Manj. 2 3 6 Staf
S1 Ekonomi 6 LPJ + Diklat 0.8 6.8 2 13.6 Manj. 2 3 6 Manj. 2 3 6 Staf
S1 Kes Mas 6 0 6.0 2 12 Manj. 1 3 3 Manj. 1 3 3 Staf
SLTA 3 Diklat 0.2 3.2 2 6.4 Manj. 1 3 3 Poli 1 3 3 Staf
D3 Rekam Medis 5 LPJ + Diklat 1.4 6.4 2 12.8 Manj. 2 3 6 Manj. 2 3 6 Anggota PPTK & K
S1 B.Inggris 6 Diklat 0.4 6.4 2 12.8 Manj. 2 3 6 Manj. 2 3 6 Staf
S1 B.Inggris 6 Diklat 0.2 6.2 2 12.4 Manj. 2 3 6 Manj. 2 3 6 Staf
D3 Manj Adm. 5 Diklat 0.2 5.2 2 10.4 Manj. 2 3 6 Manj. 2 3 6 Staf
SMK 3 0 3.0 2 6 Manj. 2 3 6 Manj. 2 3 6 Staf
SMA 3 0 3.0 2 6 Manj. 2 3 6 Manj. 2 3 6 Staf
SMK 3 0 3.0 2 6 Manj. 1 3 3 Manj. 1 3 3
D3 Rekam Medis 5 0 5.0 2 10 Manj. 1 3 3 Manj. 1 3 3 Staf
Dokter Umum 7 LPJ + Diklat 4.8 11.8 2 23.6 Manj. 1 3 3 Manj. 1 3 3 Kabid. Pelayana
dokter umum 7 LPJ + Diklat 1 8.0 2 16 Manj. 1 3 3 Manj. 1 3 3 Ka.Sub Bid. Raw
S1 Kep Ners 7 LPJ + Diklat 2.8 9.8 2 19.6 Manj. 1 3 3 Manj. 1 3 3 Ka. Subid Rawa
S1 Kes.Masy 6 LPJ + Diklat 1 7.0 2 14 Manj. 1 3 3 Manj. 1 3 3 Anggota PP
S1 Sosial 6 Diklat 0.4 6.4 2 12.8 Manj. 1 3 3 Manj. 1 3 3 Staf

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S1 Kes Mas 6 Diklat 0.4 6.4 2 12.8 Manj. 1 3 3 Manj. 1 3 3 Staf
S1 Hukum 6 Diklat 0.2 6.2 2 12.4 Manj. 1 3 3 Manj. 1 3 3 Staf
S1 Dokter Gigi 7 LPJ + Diklat 4.2 11.2 2 22.4 Manj. 1 3 3 Manj. 1 3 3 Ka.Bid.Penunjan
S1 Kes Mas 6 LPJ + Diklat 1.8 7.8 2 15.6 Manj. 1 3 3 Manj. 1 3 3 Ka. Sub Bidang
S1 Apoteker 7 LPJ + Diklat 3.4 10.4 2 20.8 Manj. 1 3 3 Manj. 1 3 3 Ka. Sub Bidang
SMK 3 LPJ + Diklat 1 4.0 2 8 Manj. 1 3 3 Manj. 1 3 3 Anggota PP
SLTA 3 LPJ + Diklat 1 4.0 2 8 Manj. 1 3 3 Manj. 1 3 3 Anggota PP
S1 Ekonomi 6 Diklat 0.4 6.4 2 12.8 Manj. 1 3 3 Manj. 1 3 3 Anggota PP
S1 Kep Ners 7 LPJ + Diklat 4.2 11.2 2 22.4 Manj. 1 3 3 Manj. 1 3 3 Ka. Bid. Keper
S1 Kep Ners 7 LPJ + Diklat 2.8 9.8 2 19.6 Manj. 1 3 3 Manj. 1 3 3 Ka. Sub bid SDM
S1 Kep Ners 7 LPJ + Diklat 1 8.0 2 16 Manj. 1 3 3 Manj. 1 3 3 Ka. Sub bid Ra
SLTA 3 LPJ + Diklat 0.8 3.8 2 7.6 Manj. 1 3 3 Manj. 1 3 3 Anggota PP
S1 Kes Mas 6 Diklat 0.8 6.8 2 13.6 Manj. 1 3 3 Manj. 1 3 3 Anggota PP
S1 Kep Ners 7 Diklat 0.2 7.2 2 14.4 Manj. 1 3 3 Manj. 1 3 3
S1 Kes. Masy 6 LPJ + Diklat 2 8.0 2 16 Manj. 1 3 3 Manj. 1 3 3 Ketua Pengadaan

SKM 6 LPJ + Diklat 3 9.0 2 18 Manj 1 3 3 Manj. 1 3 3 Pemasara
D3 Akuntansi 5 0 5.0 2 10 Manj. 1 3 3 Manj. 1 3 3 Staf
D3 Akper 5 LPJ + Diklat 3 8.0 2 16 Ruang 4 3 12 Ruang 4 3 12

S1 Kep Ners 7 LPJ + Diklat 3 10.0 2 20 Ruang 4 3 12 Ruang 4 3 12
D3 Akper 5 LPJ + Diklat 1.4 6.4 2 12.8 Ruang 4 3 12 Ruang 4 3 12 Peraw
SLTA 3 LPJ + Diklat 1 4.0 2 8 Ruang 2 3 6 Ruang 1 3 3 Staf
D3 Akper 5 Diklat 0.6 5.6 2 11.2 Ruang 4 3 12 Ruang 4 3 12

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S1 Kep Ners 7 Diklat 0.8 7.8 2 15.6 Ruang 4 3 12 Ruang 4 3 12
D3 Akper 5 0 5.0 2 10 Ruang 4 3 12 Ruang 4 3 12
D3 Akbid 5 LPJ + Diklat 1.8 6.8 2 13.6 Ruang 4 3 12 Ruang 4 3 12

D3 Akbid 5 LPJ + Diklat 2.2 7.2 2 14.4 Ruang 4 3 12 Ruang 4 3 12 Bida
D3 Akbid 5 LPJ + Diklat 1.8 6.8 2 13.6 Ruang 4 3 12 Ruang 4 3 12 Bidan P
D3 Akbid 5 LPJ + Diklat 1.8 6.8 2 13.6 Ruang 4 3 12 Ruang 4 3 12 Bida
SLTA 3 LPJ + Diklat 0.8 3.8 2 7.6 Ruang 2 3 6 Ruang 1 3 3 Staf
SD 1 LPJ + Diklat 1 2.0 2 4 Ruang 2 3 6 Ruang 1 3 3 Staf
D3 Bidan 5 LPJ + Diklat 2 7.0 2 14 Ruang 4 3 12 Ruang 4 3 12 Bidan P
D3 Bidan 5 LPJ + Diklat 1.4 6.4 2 12.8 Ruang 4 3 12 Ruang 4 3 12 Bidan P
D3 Bidan 5 LPJ 0.6 5.6 2 11.2 Ruang 4 3 12 Ruang 4 3 12
D3 Bidan 5 Diklat 1 6.0 2 12 Ruang 4 3 12 Ruang 4 3 12 Bida
D3 Bidan 5 Diklat 0.8 5.8 2 11.6 Ruang 4 3 12 Ruang 4 3 12 Bida
D3 Bidan 5 LPJ + Diklat 1.4 6.4 2 12.8 Ruang 4 3 12 Ruang 4 3 12 Bida
D3 Bidan 5 LPJ + Diklat 1.2 6.2 2 12.4 Ruang 4 3 12 Ruang 4 3 12 Bida

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D3 Bidan 5 0 5.0 2 10 Ruang 4 3 12 Ruang 4 3 12
D3 Bidan 5 0 5.0 2 10 Ruang 4 3 12 Ruang 4 3 12
D3 Bidan 5 Diklat 0.4 5.4 2 10.8 Ruang 4 3 12 Ruang 4 3 12
S1 Kep Ners 7 Diklat Neonatus 3.5 10.5 2 21 Ruang 6 3 18 Ruang 6 3 18

S1 Kep Ners 7 Diklat Neonatus 3.8 10.8 2 21.6 Ruang 6 3 18 Ruang 6 3 18
S1 Kep Ners 7 Diklat Neonatus 2.6 9.6 2 19.2 Ruang 6 3 18 Ruang 6 3 18 Perawa
D3 Akper 5 Diklat Neonatus 2.2 7.2 2 14.4 Ruang 6 3 18 Ruang 6 3 18 Peraw
D3 Akper 5 Diklat Neonatus 1.6 6.6 2 13.2 Ruang 6 3 18 Ruang 6 3 18 Peraw
D3 Akper 5 Diklat + LPJ 1.6 6.6 2 13.2 Ruang 6 3 18 Ruang 6 3 18 Peraw
D3 Akper LPJ
5 + Diklat Neonatus
2.4 7.4 2 14.8 Ruang 6 3 18 Ruang 6 3 18 Peraw
D3 Akper LPJ
5 + Diklat Neonatus
2.4 7.4 2 14.8 Ruang 6 3 18 Ruang 6 3 18 Peraw
SLTA 3 LPJ+ Diklat 1 4.0 2 8 Ruang 2 3 6 Ruang 1 3 3
SD 1 Diklat 0.2 1.2 2 2.4 Ruang 2 3 6 Ruang 1 3 3 Staf
D3 Akper 5 0.0 5.0 2 10 Ruang 6 3 18 Ruang 6 3 18
S1 Kep Ners 7 0.0 7.0 2 14 Ruang 6 3 18 Ruang 6 3 18

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S1 Kep Ners 7 LPJ + Diklat 0.8 7.8 2 15.6 Ruang 4 3 12 Ruang 4 3 12 Per
D3 Akper 5 LPJ 0.6 5.6 2 11.2 Ruang 4 3 12 Ruang 4 3 12 Peraw
SPK 3 LPJ + Diklat 1 4.0 2 8 Ruang 4 3 12 Ruang 4 3 12 Perawat
SLTA 3 LPJ + Diklat 1 4.0 2 8 Ruang 2 3 6 Ruang 1 3 3 Pemb
SMEA 3 LPJ + Diklat 1 4.0 2 8 Ruang 2 3 6 Ruang 1 3 3 Pemb
D3 Akper 5 LPJ + Diklat 1.2 6.2 2 12.4 Ruang 4 3 12 Ruang 4 3 12
Ass. Perawat 2 Diklat 1 3.0 2 6 Ruang 2 3 6 Ruang 1 3 3 Pemb
S1 Kep 6 Diklat 0.4 6.4 2 12.8 Ruang 4 3 12 Ruang 4 3 12
S1 Kep Ners 7 LPJ + Diklat 2.8 9.8 2 19.6 Ruang 4 3 12 Ruang 4 3 12

SLTA 3 LPJ + Diklat 0.8 3.8 2 7.6 Ruang 2 3 6 Ruang 1 3 3 Pemb

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S1 Kep Ners 7 0 7.0 2 14 Ruang 4 3 12 Ruang 4 3 12
S1 Kep Ners 7 LPJ + Diklat 2.6 9.6 2 19.2 Ruang 4 3 12 Ruang 4 3 12 Per
S1 Kep 6 Diklat 0.2 6.2 2 12.4 Ruang 4 3 12 Ruang 4 3 12

Page 40 of 248


S1 Kep Ners 7 LPJ + Diklat 3.4 10.4 2 20.8 Ruang 4 3 12 Ruang 4 3 12 Sek.Komper
D3 Akper 5 LPJ + Diklat 1.4 6.4 2 12.8 Ruang 4 3 12 Ruang 4 3 12 Perawat
D3 Akper 5 LPJ + Diklat 1 6.0 2 12 Ruang 4 3 12 Ruang 4 3 12 Peraw
SLTP 2 LPJ + Diklat 1 3.0 2 6 Ruang 2 3 6 Ruang 1 3 3 Pemb
SLTP 2 Diklat 0.2 2.2 2 4.4 Ruang 2 3 6 Ruang 1 3 3 Staf


Page 41 of 248



SMEA 3 LPJ + Diklat 0.8 3.8 2 7.6 Ruang 2 3 6 Ruang 1 3 3 Pemb

Page 42 of 248



D4 Keperawatan 6 LPJ 0.6 6.6 2 13.2 Ruang 4 3 12 Ruang 4 3 12

Page 43 of 248

SLTP 2 Diklat 0.2 2.2 2 4.4 Ruang 2 3 6 Ruang 1 3 3 Staf
S1 Kep Ners 7 LPJ + Diklat Instr 1.8 8.8 2 17.6 Inst. 6 3 18 Inst. 6 3 18 Ka.Ruan
SPK 3 LPJ 0.6 3.6 2 7.2 Inst. 6 3 18 Inst. 6 3 18 Peraw
D3 Akper 5 LPJ + Diklat 1.2 6.2 2 12.4 Inst. 6 3 18 Inst. 6 3 18 Peraw
D3 Akbid 5 LPJ + Diklat 1.2 6.2 2 12.4 Inst. 6 3 18 Inst. 6 3 18 Bida
S1 Kep Ners 7 LPJ +Diklat Instr 2.2 9.2 2 18.4 Inst. 6 3 18 Inst. 6 3 18 Peraw
S1 Kep Ners 7 LPJ + Diklat 2.6 9.6 2 19.2 Inst. 6 3 18 Inst. 6 3 18 Peraw
D3 Akper 5 Diklat Instrumen 1.6 6.6 2 13.2 Inst. 6 3 18 Inst. 6 3 18 Peraw
S1 Kep Ners 7 LPJ 0.6 7.6 2 15.2 Inst. 6 3 18 Inst. 6 3 18 Peraw
D3 Akper 5 LPJ + Diklat 1 6.0 2 12 Inst. 6 3 18 Inst. 6 3 18 Peraw
SLTA 3 LPJ + Diklat 1 4.0 2 8 Inst. 2 3 6 Inst. 1 3 3 Pemb
SLTA 3 LPJ + Diklat 0.8 3.8 2 7.6 Inst. 2 3 6 Inst. 1 3 3 Pemb
D3 Kebidanan 5 LPJ + Diklat 0.8 5.8 2 11.6 Inst. 6 3 18 Inst. 6 3 18 Bida
D3 Akper 5 LPJ + Diklat 0.8 5.8 2 11.6 Inst. 6 3 18 Inst. 6 3 18
SLTA 3 Diklat 0.2 3.2 2 6.4 Inst. 2 3 6 Inst. 1 3 3 Staf

Page 44 of 248

SMK 3 Diklat 0.2 3.2 2 6.4 Inst. 2 3 6 Inst. 1 3 3 Staf
SLTP 2 Diklat 0.2 2.2 2 4.4 Inst. 2 3 6 Inst. 1 3 3 Staf
D3 Akper 5 Diklat 0.2 5.2 2 10.4 Inst. 6 3 18 Inst. 6 3 18
S1 Kep Ners 7 Diklat 1.8 8.8 2 17.6 Inst. 6 3 18 Inst. 6 3 18
S1 Kep Ners 7 LPJ + Diklat 1.6 8.6 2 17.2 Inst. 6 3 18 Inst. 6 3 18 Ka.Komper
D3 Akper 5 LPJ 0.6 5.6 2 11.2 Inst. 6 3 18 Inst. 6 3 18 Peraw
S1 Kep Ners L
7PJ + Diklat Anestesi
2.4 9.4 2 18.8 Inst. 6 3 18 Inst. 6 3 18 Peraw
D3 Anastesi 5 LPJ + Diklat 3.2 8.2 2 16.4 Inst. 6 3 18 Inst. 6 3 18 Peraw
D3 Akper L
5PJ + Diklat Anestesi2 7.0 2 14 Inst. 6 3 18 Inst. 6 3 18 Peraw
D3 Akper L
5PJ + Diklat Anestesi
2.2 7.2 2 14.4 Inst. 6 3 18 Inst. 6 3 18 Peraw
Apoteker 7 LPJ + Diklat 2.4 9.4 2 18.8 Unit 2 3 6 Unit 1 3 3 komjang

SLTP 2 LPJ + Diklat 1.4 3.4 2 6.8 Unit 2 3 6 Unit 1 3 3 Staf USS
SLTA 3 0 3.0 2 6 Unit 2 3 6 Unit 1 3 3 Staf USS

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S1 Kep Ners 7 LPJ + Diklat ICU 2.8 9.8 2 19.6 Inst. 6 3 18 Inst. 6 3 18 Wakar
D3 Akper 5 LPJ + Diklat 3.5 8.5 2 17 Inst. 6 3 18 Inst. 6 3 18 Peraw
SLTA 3 LPJ + Diklat 1.2 4.2 2 8.4 Inst. 2 3 6 Inst. 1 3 3 Pemb
D3 Akper 5 Diklat ICU 0.8 5.8 2 11.6 Inst. 6 3 18 Inst. 6 3 18
S1 Kep Ners 7 0 7.0 2 14 Inst. 6 3 18 Inst. 6 3 18
S1 Kep Ners 7 0 7.0 2 14 Inst. 6 3 18 Inst. 6 3 18
D3 Akper 5 0 5.0 2 10 Inst. 6 3 18 Inst. 6 3 18
D3 Akper 5 0 5.0 2 10 Inst. 6 3 18 Inst. 6 3 18

D3 Akper 5 LPJ+Diklat 2.2 7.2 2 14.4 Inst. 6 3 18 Inst. 6 3 18 Peraw
D3 Bidan 5 LPJ + Diklat 2 7.0 2 14 Inst. 6 3 18 Inst. 6 3 18 Bida

Page 46 of 248

SLTA 3 LPJ + Diklat 1 4.0 2 8 Inst. 2 3 6 Inst. 1 3 3 Pemb
SLTA 3 LPJ + Diklat 0.8 3.8 2 7.6 Inst. 2 3 6 Inst. 1 3 3 Staf
SMA 3 Diklat 0.2 3.2 2 6.4 Inst. 2 3 6 Inst. 1 3 3 Staf
D3 Akbid 5 LPJ + Diklat 1.6 6.6 2 13.2 Inst. 6 3 18 Inst. 6 3 18
S1 Kep 6 Diklat 0.4 6.4 2 12.8 Inst. 6 3 18 Inst. 6 3 18
S1 Komunikasi 6 Diklat 0.2 6.2 2 12.4 Inst. 2 3 6 Inst. 1 3 3 Staf
D3 Bidan 5 Diklat 0.4 5.4 2 10.8 Inst. 6 3 18 Inst. 6 3 18
D3 Bidan 5 Diklat 0.4 5.4 2 10.8 Inst. 6 3 18 Inst. 6 3 18
S1 Kep 6 Diklat 0.2 6.2 2 12.4 Inst. 6 3 18 Inst. 6 3 18
D3 Akper 5 0.0 5.0 2 10 Inst. 6 3 18 Inst. 6 3 18
D3 Akper 5 0.0 5.0 2 10 Inst. 6 3 18 Inst. 6 3 18
D3 Akper 5 0.0 5.0 2 10 Inst. 6 3 18 Inst. 6 3 18
D3 Bidan 5 Diklat 1.2 6.2 2 12.4 Inst. 6 3 18 Inst. 6 3 18 Bida
D3 Akper 5 0.0 5.0 2 10 Inst. 6 3 18 Inst. 6 3 18

Page 47 of 248

D3 Akper 5 0.0 5.0 2 10 Inst. 6 3 18 Inst. 6 3 18
S1 Kep Ners 7 LPJ + Diklat HD 4.4 11.4 2 22.8 Ruang 4 3 12 Ruang 4 3 12 Ka.Ruan
D3 Akper 5 LPJ + Diklat HD 2.6 7.6 2 15.2 Ruang 4 3 12 Ruang 4 3 12 Peraw
D3 Akper 5 LPJ+ Diklat 1.4 6.4 2 12.8 Ruang 4 3 12 Ruang 4 3 12 Peraw
D3 Akper 5 LPJ + Diklat HD 2 7.0 2 14 Ruang 4 3 12 Ruang 4 3 12 Peraw
S1 Kep Ners 7 LPJ + Diklat HD 3.2 10.2 2 20.4 Ruang 4 3 12 Ruang 4 3 12 Peraw
D3 Akper 5 LPJ + Diklat HD 3.6 8.6 2 17.2 Ruang 4 3 12 Ruang 4 3 12Pemeriksa Barang
D3 Akper 5 Diklat HD 1.2 6.2 2 12.4 Ruang 4 3 12 Ruang 4 3 12
SLTA 3 Diklat HD 0.2 3.2 2 6.4 Ruang 2 3 6 Ruang 1 3 3 Staf
D3 Akper 5 Diklat HD 1.4 6.4 2 12.8 Ruang 4 3 12 Ruang 4 3 12
S1 Kep Ners 7 LPJ + Dklt Endos 3.8 10.8 2 21.6 Poli 4 3 12 Poli 2 3 6 Ka.P
S1 Kep Ners 7 LPJ + Dklt Endos 5 12.0 2 24 Poli 4 3 12 Poli 2 3 6 Peraw
D3 Akper 5 LPJ + Diklat 1.2 6.2 2 12.4 Poli 4 3 12 Poli 2 3 6 Peraw
SMA 3 Diklat 0.2 3.2 2 6.4 Poli 2 3 6 Poli 1 3 3 Staf
D3 Akper 5 LPJ + Diklat 1.2 6.2 2 12.4 Poli 2 3 6 Poli 2 3 6

S1 Kep 6 Diklat 0.2 6.2 2 12.4 Poli 2 3 6 Poli 2 3 6
S1 Kep Ners 7 LPJ + Diklat 3.2 10.2 2 20.4 Poli 4 3 12 Poli 2 3 6

Page 48 of 248

D3 Akper 5 LPJ 0.6 5.6 2 11.2 Poli 4 3 12 Poli 2 3 6 Peraw
S1 Kep Ners 7 LPJ + Diklat 1.6 8.6 2 17.2 Poli 2 3 6 Poli 2 3 6 Peraw
D3 Akper 5 Diklat 0.6 5.6 2 11.2 Poli 2 3 6 Poli 2 3 6

D3 Akper 5 LPJ + Diklat 1 6.0 2 12 Poli 2 3 6 Poli 2 3 6 Peraw
S1 Kep Ners 7 LPJ + Diklat 2 9.0 2 18 Poli 2 3 6 Poli 2 3 6

D3 Akper 5 LPJ + Diklat 1.2 6.2 2 12.4 Poli 2 3 6 Poli 2 3 6 Perawa
D3 Bidan 5 LPJ + Diklat 1 6.0 2 12 Poli 2 3 6 Poli 2 3 6 Bida

D3 Akper 5 LPJ + Diklat 1.4 6.4 2 12.8 Poli 2 3 6 Poli 2 3 6 Ka. P

D3 Akper 5 LPJ + Diklat 1 6.0 2 12 Poli 2 3 6 Poli 2 3 6 Perawa

Page 49 of 248


D3 Refraksionis 5 LPJ + Diklat 0.8 5.8 2 11.6 Poli 2 3 6 Poli 2 3 6
D3 Refraksionis 5 LPJ + Diklat 0.8 5.8 2 11.6 Poli 2 3 6 Poli 2 3 6
D3 Refraksionis 5 Diklat 0.2 5.2 2 10.4 Poli 2 3 6 Poli 2 3 6 Staf
D3 Refraksionis 5 LPJ 0.6 5.6 2 11.2 Poli 2 3 6 Poli 2 3 6
D3 Akper 5 0 5.0 2 10 Poli 2 3 6 Poli 2 3 6
D3 Akbid 5 LPJ + Diklat 1.8 6.8 2 13.6 Poli 2 3 6 Poli 2 3 6 Bida

D3 Akbid 5 Diklat 0.8 5.8 2 11.6 Poli 2 3 6 Poli 2 3 6 Bida
D3 Bidan 5 LPJ + Diklat 2.2 7.2 2 14.4 Poli 2 3 6 Poli 2 3 6 Bida

D 3 Akbid 5 LPJ + Diklat 2 7.0 2 14 Poli 2 3 6 Poli 2 3 6 Bida

D3 Perawat Gigi 5 LPJ + Diklat 1.2 6.2 2 12.4 Poli 2 3 6 Poli 2 3 6

SPRG 3 LPJ 0.6 3.6 2 7.2 Poli 2 3 6 Poli 2 3 6 Peraw
SMA 3 Diklat 0.2 3.2 2 6.4 Poli 2 3 6 Poli 1 3 3 Staf
D3 Perawat Gigi 5 0 5.0 2 10 Poli 2 3 6 Poli 2 3 6

D3 Akper 5 LPJ + Diklat 1.2 6.2 2 12.4 Poli 2 3 6 Poli 2 3 6 Perawa
SLTA 3 LPJ + Diklat 1 4.0 2 8 Poli 2 3 6 Poli 1 3 3 Pemb

Page 50 of 248

D1 Jiwa 4 LPJ + Diklat 1.4 5.4 2 10.8 Poli 2 3 6 Poli 2 3 6 Perawat

D3 Akper 5 0 5.0 2 10 Poli 2 3 6 Poli 2 3 6
S1 Kes Mas 6 0 6.0 2 12 Poli 2 3 6 Poli 2 3 6
D3 Fisioterapi 5 LPJ + Diklat 2.2 7.2 2 14.4 Poli 2 3 6 Poli 2 3 6 Ka.P

D3 Fisioterapi 5 LPJ + Diklat 2.4 7.4 2 14.8 Poli 2 3 6 Poli 2 3 6 Pelaks
D3 Fisioterapi 5 LPJ + Diklat 2.4 7.4 2 14.8 Poli 2 3 6 Poli 2 3 6 Peraw
D3 Fisioterapi 5 Diklat 0.4 5.4 2 10.8 Poli 2 3 6 Poli 2 3 6
SLTA 3 Diklat 0.2 3.2 2 6.4 Poli 2 3 6 Poli 1 3 3 Staf
S1 Sastra 6 Diklat 0.2 6.2 2 12.4 Poli 2 3 6 Poli 1 3 3 Staf
D3 T.Wicara 5 Diklat 0.2 5.2 2 10.4 Poli 2 3 6 Poli 2 3 6
D3 Fisioterapi 5 0 5.0 2 10 Poli 2 3 6 Poli 2 3 6 Pelaks
D3 Fisioterapi 5 0 5.0 2 10 Poli 2 3 6 Poli 2 3 6 Pelaks
D3 Analis 5 LPJ + Diklat 0.8 5.8 2 11.6 Poli 2 3 6 Poli 2 3 6 Labora

D3 Analis 5 LPJ + Diklat 1.6 6.6 2 13.2 Poli 2 3 6 Poli 2 3 6 Labora
D3 Analis 5 0 5.0 2 10 Poli 2 3 6 Poli 2 3 6
D3 Gizi 5 LPJ + Diklat 3.8 8.8 2 17.6 Poli 2 3 6 Poli 2 3 6 Ka poli
D3 Akper 5 LPJ +Diklat 3 8.0 2 16 Inst. 6 3 18 Inst. 4 3 12

SLTP 2 LPJ +Diklat 0.8 2.8 2 5.6 Inst. 6 3 18 Inst. 4 3 12 Staf
D3 Akper 5 Diklat 0.2 5.2 2 10.4 Inst. 6 3 18 Inst. 4 3 12 Staf
D3 Akper 5 Diklat 0.2 5.2 2 10.4 Inst. 6 3 18 Inst. 4 3 12 Staf

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D3 Radiologi 5 LPJ + Diklat 2.2 7.2 2 14.4 Inst. 6 3 18 Inst. 4 3 12 Ka.Ruang

D3 Radiologi 5 LPJ + Diklat 1.6 6.6 2 13.2 Inst. 6 3 18 Inst. 4 3 12 Radiogra
D3 Radiologi 5 LPJ + Diklat 1.6 6.6 2 13.2 Inst. 6 3 18 Inst. 4 3 12 Pemeriksa B
D3 Radiologi 5 LPJ + Diklat 1 6.0 2 12 Inst. 6 3 18 Inst. 4 3 12 Radiogr
SLTA 3 LPJ + Diklat 0.6 3.6 2 7.2 Inst. 4 3 12 Inst. 2 3 6
SLTP 2 LPJ + Diklat 0.6 2.6 2 5.2 Inst. 4 3 12 Inst. 2 3 6
SLTP 2 LPJ + Diklat 1 3.0 2 6 Inst. 4 3 12 Inst. 2 3 6
D3 Radiologi 5 Diklat 0.2 5.2 2 10.4 Inst. 6 3 18 Inst. 4 3 12 Radiogr
D3 Radiologi 5 0 5.0 2 10 Inst. 6 3 18 Inst. 4 3 12 Radiogr
D3 Radiologi 5 0 5.0 2 10 Inst. 6 3 18 Inst. 4 3 12 Radiogr
D3 Analis 5 LPJ + Diklat 1.8 6.8 2 13.6 Inst. 4 3 12 Inst. 4 3 12

S1 Biologi 6 LPJ + Diklat 1.4 7.4 2 14.8 Inst. 4 3 12 Inst. 4 3 12 Pemeriksa B
D3 Analis 5 LPJ + Diklat 1.2 6.2 2 12.4 Inst. 4 3 12 Inst. 4 3 12 Laborat
D3 Analis 5 LPJ + Diklat 1.2 6.2 2 12.4 Inst. 4 3 12 Inst. 4 3 12 Labora
D3 Analis 5 LPJ + Diklat 1 6.0 2 12 Inst. 4 3 12 Inst. 4 3 12 Labora
SLTA 3 LPJ + Diklat 0.8 3.8 2 7.6 Inst. 4 3 12 Inst. 4 3 12 Labora
SLTP 2 LPJ + Diklat 1 3.0 2 6 Inst. 4 3 12 Inst. 2 3 6

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D3 Analis 5 Diklat 0.2 5.2 2 10.4 Inst. 4 3 12 Inst. 4 3 12
D3 Analis 5 0 5.0 2 10 Inst. 4 3 12 Inst. 4 3 12
SMA 3 0 3.0 2 6 Inst. 4 3 12 Inst. 2 3 6

S1 Gizi 6 LPJ + Diklat 5.4 11.4 2 22.8 Inst. 2 3 6 Inst. 2 3 6

D1 Gizi 4 LPJ + Diklat 3.6 7.6 2 15.2 Inst. 2 3 6 Inst. 2 3 6 Pemeriksa Barang
S1 Gizi 6 LPJ + Diklat 3 9.0 2 18 Inst. 2 3 6 Inst. 2 3 6 Nutrisionis Pe
D3 Gizi 5 LPJ + Diklat 2.4 7.4 2 14.8 Inst. 2 3 6 Inst. 2 3 6 Pemeriksa B
D3 Gizi 5 LPJ + Diklat 1.8 6.8 2 13.6 Inst. 2 3 6 Inst. 2 3 6 Nutrisionis Pe
D3 Gizi 5 LPJ + Diklat 2.2 7.2 2 14.4 Inst. 2 3 6 Inst. 2 3 6 Nutrisionis Pe
D3 Gizi 5 LPJ + Diklat 2.6 7.6 2 15.2 Inst. 2 3 6 Inst. 2 3 6 Nutrisionis Pela
D3 Gizi 5 LPJ + Diklat 1 6.0 2 12 Inst. 2 3 6 Inst. 2 3 6 Nutrisionis Pel
SLTA 3 LPJ + Diklat 1 4.0 2 8 Inst. 2 3 6 Inst. 2 3 6 Staf
SPAG/D1 Gizi 4 LPJ + Diklat 1.4 5.4 2 10.8 Inst. 2 3 6 Inst. 2 3 6 Staf

Page 53 of 248

SMKK 3 LPJ + Diklat 1.2 4.2 2 8.4 Inst. 2 3 6 Inst. 2 3 6 Staf
SLTP 2 LPJ + Diklat 1 3.0 2 6 Inst. 2 3 6 Inst. 2 3 6 Staf
SLTP 2 LPJ + Diklat 1.2 3.2 2 6.4 Inst. 2 3 6 Inst. 2 3 6 Staf
SD 1 LPJ + Diklat 1 2.0 2 4 Inst. 2 3 6 Inst. 2 3 6 Staf
SD 1 LPJ + Diklat 1.2 2.2 2 4.4 Inst. 2 3 6 Inst. 2 3 6 Staf
SD 1 LPJ + Diklat 1 2.0 2 4 Inst. 2 3 6 Inst. 2 3 6 Staf
D1 Perhotelan 4 Diklat 0.4 4.4 2 8.8 Inst. 2 3 6 Inst. 2 3 6 Staf
D1 Gizi 4 Diklat 0.4 4.4 2 8.8 Inst. 2 3 6 Inst. 2 3 6 Staf
SMKK 3 Diklat 0.4 3.4 2 6.8 Inst. 2 3 6 Inst. 2 3 6 Staf
D3 Gizi 5 Diklat 0.4 5.4 2 10.8 Inst. 2 3 6 Inst. 2 3 6 Staf
SMK Tt Boga 3 Diklat 0.4 3.4 2 6.8 Inst. 2 3 6 Inst. 2 3 6 Staf
S1 Gizi 6 0 6.0 2 12 Inst. 2 3 6 Inst. 2 3 6 Staf
D3 Gizi 5 0 5.0 2 10 Inst. 2 3 6 Inst. 2 3 6 Staf
D4 TEM 6 LPJ + Diklat 2.4 8.4 2 16.8 Inst. 2 3 6 Inst. 4 3 12 Ka.Instalasi

STM 3 LPJ + Diklat 1.2 4.2 2 8.4 Inst. 2 3 6 Inst. 4 3 12 Pemeriksa B
STM 3 LPJ + Diklat 1 4.0 2 8 Inst. 2 3 6 Inst. 4 3 12
STM 3 LPJ + Diklat 0.8 3.8 2 7.6 Inst. 2 3 6 Inst. 4 3 12 Pemeriksa B

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D3 Atem 5 LPJ + Diklat 1.6 6.6 2 13.2 Inst. 2 3 6 Inst. 4 3 12 Pemeriksa B
D3 Atem 5 LPJ + Diklat 2 7.0 2 14 Inst. 2 3 6 Inst. 4 3 12 Pemeriksa B
D3 Atem 5 LPJ + Diklat 2.2 7.2 2 14.4 Inst. 2 3 6 Inst. 4 3 12 Anggota Penguru
D3 Elektro 5 Diklat 0.2 5.2 2 10.4 Inst. 2 3 6 Inst. 4 3 12 Staf
STM 3 Diklat 0.2 3.2 2 6.4 Inst. 2 3 6 Inst. 4 3 12 Staf
D3 Komputer 5 Diklat 0.2 5.2 2 10.4 Inst. 2 3 6 Inst. 4 3 12 Staf
D3 Atem 5 Diklat 0.6 5.6 2 11.2 Inst. 2 3 6 Inst. 4 3 12 Staf
D3 Atem 5 Diklat 0.2 5.2 2 10.4 Inst. 2 3 6 Inst. 4 3 12 Staf
SMK 3 0 3.0 2 6 Inst. 1 3 3 Inst. 1 3 3
SMK 3 0 3.0 2 6 Inst. 1 3 3 Inst. 1 3 3
SMK 3 0 3.0 2 6 Inst. 1 3 3 Inst. 1 3 3
SMK 3 0 3.0 2 6 Inst. 1 3 3 Inst. 1 3 3
D3 TEM 5 0 5.0 2 10 Inst. 1 3 3 Inst. 1 3 3
D3 TEM 5 0 5.0 2 10 Inst. 1 3 3 Inst. 1 3 3
S1 Sosial 6 LPJ + Diklat 1.6 7.6 2 15.2 Inst. 6 3 18 Inst. 2 3 6 Ka. Instalasi
S1 Tehnik Ling 6 LPJ + Diklat 4.4 10.4 2 20.8 Inst. 6 3 18 Inst. 2 3 6 Koord. Loundry
S1 Tehnik Ling 6 LPJ + Diklat 2 8.0 2 16 Inst. 6 3 18 Inst. 2 3 6 Anggota PP
SKM 6 LPJ + Diklat 2.2 8.2 2 16.4 Inst. 6 3 18 Inst. 2 3 6 Anggota PP
SLTA 3 LPJ + Diklat 0.8 3.8 2 7.6 Inst. 6 3 18 Inst. 2 3 6 Staf
STM 3 LPJ + Diklat 0.8 3.8 2 7.6 Inst. 6 3 18 Inst. 2 3 6 Staf
SMA 3 LPJ + Diklat 0.8 3.8 2 7.6 Inst. 6 3 18 Inst. 2 3 6 Staf
SLTA 3 Diklat 0.2 3.2 2 6.4 Inst. 6 3 18 Inst. 2 3 6 Staf Loundry
SLTA 3 Diklat 0.2 3.2 2 6.4 Inst. 6 3 18 Inst. 2 3 6 Staf Loundry
SMEA 3 LPJ + Diklat 0.8 3.8 2 7.6 Inst. 6 3 18 Inst. 2 3 6 Staf Loundry

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STM 3 LPJ + Diklat 1 4.0 2 8 Inst. 6 3 18 Inst. 2 3 6 Staf
D3 KESLING 5 0 5.0 2 10 Inst. 6 3 18 Inst. 2 3 6 Staf
S1 Apoteker 7 LPJ + Diklat 1.8 8.8 2 17.6 Inst. 2 3 6 Inst. 2 3 6

SMF 3 LPJ + Diklat 1 4.0 2 8 Inst. 2 3 6 Inst. 2 3 6
D3 Analis Farmasi 5 LPJ + Diklat 0.8 5.8 2 11.6 Inst. 2 3 6 Inst. 2 3 6 Ass. Ap
S2 Farm-klin 8 LPJ + Diklat 1.2 9.2 2 18.4 Inst. 4 3 12 Inst. 2 3 6
S1 Apoteker 7 LPJ + Diklat 1.4 8.4 2 16.8 Inst. 2 3 6 Inst. 2 3 6
D3 Farmasi 5 LPJ + Diklat 2.2 7.2 2 14.4 Inst. 2 3 6 Inst. 2 3 6 Ass. Ap
SMF 3 LPJ + Diklat 0.8 3.8 2 7.6 Inst. 2 3 6 Inst. 2 3 6 Ass. Ap
SMF 3 LPJ + Diklat 1 4.0 2 8 Inst. 4 3 12 Inst. 2 3 6 Ass. Ap
D3 Farmasi 5 LPJ + Diklat 1.2 6.2 2 12.4 Inst. 2 3 6 Inst. 2 3 6 Pembantu Pengur
SMF 3 LPJ + Diklat 0.8 3.8 2 7.6 Inst. 2 3 6 Inst. 2 3 6 Ass. Ap
SMF 3 LPJ + Diklat 0.8 3.8 2 7.6 Inst. 4 3 12 Inst. 2 3 6 Ass.A
SMF 3 LPJ + Diklat 1 4.0 2 8 Inst. 4 3 12 Inst. 2 3 6 Ass.A
SMF 3 LPJ + Diklat 1 4.0 2 8 Inst. 2 3 6 Inst. 2 3 6 Ass.A
SLTA 3 LPJ + Diklat 1 4.0 2 8 Inst. 4 3 12 Inst. 2 3 6 Pemeriksa B
SMA 3 LPJ + Diklat 0.8 3.8 2 7.6 Inst. 2 3 6 Inst. 1 3 3 Pemeriksa B
SMA 3 LPJ + Diklat 1 4.0 2 8 Inst. 2 3 6 Inst. 1 3 3 Staf
SMA 3 LPJ + Diklat 0.8 3.8 2 7.6 Inst. 2 3 6 Inst. 1 3 3 Staf
D3 Analis Farmasi 5 LPJ + Diklat 0.8 5.8 2 11.6 Inst. 2 3 6 Inst. 2 3 6 Pemeriksa B
D3 Analis Farmasi 5 LPJ + Diklat 0.8 5.8 2 11.6 Inst. 2 3 6 Inst. 2 3 6 Ass.A

Page 56 of 248

SMF 3 LPJ + Diklat 1 4.0 2 8 Inst. 2 3 6 Inst. 2 3 6 Staf
S1 Apoteker 7 Diklat 0.2 7.2 2 14.4 Inst. 2 3 6 Inst. 2 3 6
D3 Analis Farmasi 5 Diklat 0.2 5.2 2 10.4 Inst. 2 3 6 Inst. 2 3 6
D3 Farmasi 5 Diklat 0.2 5.2 2 10.4 Inst. 2 3 6 Inst. 2 3 6
SMF 3 Diklat 0.2 3.2 2 6.4 Inst. 4 3 12 Inst. 2 3 6
S2 Farm-klin 8 Diklat 0.2 8.2 2 16.4 Inst. 4 3 12 Inst. 2 3 6
S1 Apoteker 7 0 7.0 2 14 Inst. 2 3 6 Inst. 2 3 6
S1 Tehnik Komp 6 LPJ + Diklat 2 8.0 2 16 Manj. 4 3 12 Manj. 2 3 6 Ka.Unit

D3 Komputer 5 LPJ + Diklat 3.4 8.4 2 16.8 Manj. 4 3 12 Manj. 2 3 6 Sek.Tim Peng
D3 Komputer 5 LPJ + Diklat 0.8 5.8 2 11.6 Manj. 4 3 12 Manj. 2 3 6 Staf
D3 Komputer 5 LPJ + Diklat 1.4 6.4 2 12.8 Manj. 4 3 12 Manj. 2 3 6 Pemeriksa B
SMEA 3 LPJ + Diklat 0.8 3.8 2 7.6 Manj. 4 3 12 Manj. 2 3 6 Staf

Page 57 of 248

D1 Komputer 4 LPJ + Diklat 0.8 4.8 2 9.6 Manj. 4 3 12 Manj. 2 3 6 Staf
S1 Komputer 6 Diklat 0.2 6.2 2 12.4 Manj. 4 3 12 Manj. 2 3 6 Staf
D1 Komputer 4 Diklat 0.2 4.2 2 8.4 Manj. 4 3 12 Manj. 2 3 6 Staf
D3 T.Komputer 5 Diklat 0.2 5.2 2 10.4 Manj. 4 3 12 Manj. 2 3 6 Staf
D3 Informatika 5 Diklat 0.2 5.2 2 10.4 Manj. 4 3 12 Manj. 2 3 6 Staf
S1 Fisika 6 Diklat 0.2 6.2 2 12.4 Manj. 4 3 12 Manj. 2 3 6 Staf
D3 Informatika 5 0 5.0 2 10 Manj. 4 3 12 Manj. 2 3 6 Staf
S1 Komputer 6 Diklat 0.2 6.2 2 12.4 Manj. 4 3 12 Manj. 2 3 6 Staf
S1 Kes Mas 6 LPJ + Diklat 2.6 8.6 2 17.2 Manj. 1 3 3 Manj. 1 3 3 Ka. Unit K3RS
D4 Atem 6 LPJ + Diklat 4 10.0 2 20 Manj. 1 3 3 Manj. 1 3 3 Pemeriksa B
D3 Hiperkes 5 Diklat 0.2 5.2 2 10.4 Manj. 1 3 3 Manj. 1 3 3

STM 3 LPJ + Diklat 1.2 4.2 2 8.4 Manj. 4 3 12 Manj. 2 3 6 Staf
SLTP 2 Diklat 0.2 2.2 2 4.4 Manj. 4 3 12 Manj. 2 3 6 Staf

SLTP 2 LPJ + Diklat 1 3.0 2 6 Manj. 2 3 6 Manj. 2 3 6 Staf
SD 1 LPJ + Diklat 0.8 1.8 2 3.6 Manj. 2 3 6 Manj. 2 3 6 Staf
SD 1 LPJ + Diklat 0.8 1.8 2 3.6 Manj. 2 3 6 Manj. 2 3 6 Staf
SLTA 3 LPJ + Diklat 2.4 5.4 2 10.8 Manj. 2 3 6 Manj. 2 3 6 Koordinator

STM 3 LPJ + Diklat 1 4.0 2 8 Manj. 2 3 6 Manj. 2 3 6 Staf
S1 Hukum 6 LPJ + Diklat 1 7.0 2 14 Manj. 2 3 6 Manj. 2 3 6 Staf

Page 58 of 248

SLTP 2 LPJ + Diklat 1.4 3.4 2 6.8 Manj. 2 3 6 Manj. 2 3 6 Staf
SMK 3 Diklat 0.4 3.4 2 6.8 Manj. 2 3 6 Manj. 2 3 6 Staf
D1 Komputer 3 Diklat 0.2 3.2 2 6.4 Manj. 1 3 3 Manj. 1 3 3 Staf Adm

SLTP 2 Diklat 0.2 2.2 2 4.4 Manj. 1 3 3 Manj. 1 3 3 Staf
Dokter Spes 8 LPJ + Diklat 1 9.0 2 18 6 3 18 6 3 18

Dokter Gigi 7 LPJ + Diklat 1.2 8.2 2 16.4 2 3 6 2 3 6
S2 Mag. Kes 8 LPJ + Diklat 4.0 12.0 2 24 6 3 18 6 3 18 Penanggung
Dokter Umum 7 LPJ 0.6 7.6 2 15.2 Manj. 1 3 3 Manj. 1 3 3
S1 Dokter Gigi 7 LPJ + Diklat 3.8 10.8 2 21.6 Manj. 1 3 3 Manj. 1 3 3 Ka. PPKRS
Dokter Spes 8 LPJ + Diklat 1.4 9.4 2 18.8 6 3 18 6 3 18 Ka.
Dokter Spes 8 LPJ + Diklat 1.2 9.2 2 18.4 6 3 18 6 3 18
Dokter Spes Gizi klinik8 LPJ + Diklat 9.2 17.2 2 34.4 2 3 6 2 3 6
Dokter Spes 8 LPJ + Diklat 1 9.0 2 18 6 3 18 6 3 18 Ka. K
Dokter Spes 8 LPJ + Diklat 0.8 8.8 2 17.6 4 3 12 6 3 18 Ka. KSM

Page 59 of 248

Dokter Gigi 7 LPJ + Diklat 0.8 7.8 2 15.6 2 3 6 2 3 6
Dokter Spes 8 LPJ + Diklat 1.6 9.6 2 19.2 4 3 12 4 3 12 Ka. K
Dokter Gigi Spes. 8 LPJ + Diklat 0.8 8.8 2 17.6 2 3 6 2 3 6
Dokter Umum 7 LPJ + Diklat 3.4 10.4 2 20.8 1 3 3 1 3 3
Dokter Spes 8 LPJ + Diklat 0.8 8.8 2 17.6 4 3 12 6 3 18 Ka. Inst
Dokter Umum 7 LPJ + Diklat 3.5 10.5 2 21 6 3 18 6 3 18
Dokter Spes 8 LPJ + Diklat 0.8 8.8 2 17.6 6 3 18 6 3 18 Ka. KS
Dokter Umum 7 LPJ + Diklat 3.8 10.8 2 21.6 6 3 18 6 3 18 Ka. IGD/Ka. K
Dokter Spes 8 LPJ 0.6 8.6 2 17.2 6 3 18 6 3 18
dokter umum 7 LPJ + Diklat 1.2 8.2 2 16.4 6 3 18 6 3 18
dokter Spes Anak 8 LPJ + Diklat 1.2 9.2 2 18.4 6 3 18 6 3 18
dokter Spes syaraf 8 LPJ + Diklat 0.8 8.8 2 17.6 6 3 18 6 3 18
Dokter Spes 8 Diklat 1.4 9.4 2 18.8 6 3 18 6 3 18
Dokter Spes 8 Diklat 0.4 8.4 2 16.8 6 3 18 6 3 18 KSM
Dokter Spes 8 LPJ 0.6 8.6 2 17.2 6 3 18 6 3 18
Dokter Spes 8 LPJ 0.6 8.6 2 17.2 6 3 18 6 3 18 Ka.
Dokter Spes 8 0 8 2 16 6 3 18 6 3 18 KSM
Dokter Umum 7 Diklat 0.2 7.2 2 14.4 6 3 18 6 3 18
Dokter Spes 8 LPJ 0.6 8.6 2 17.2 6 3 18 6 3 18
Dokter Spes 8 LPJ 0.6 8.6 2 17.2 6 3 18 6 3 18

Page 60 of 248

Dokter Spes 8 LPJ 0.6 8.6 2 17.2 2 3 6 2 3 6
Dokter Spes 8 0 8 2 16 6 3 18 6 3 18
Dokter Umum 7 0 7 2 14 6 3 18 6 3 18
Dokter Spes 8 LPJ 0.6 8.6 2 17.2 2 3 6 2 3 6
Dokter Spes 8 LPJ 0.6 8.6 2 17.2 6 3 18 6 3 18
Dokter Spes 8 0 8 2 16 6 3 18 6 3 18
Dokter Spes 8 0 8 2 16 6 3 18 6 3 18
Dokter Spes 8 0 8 2 16 6 3 18 6 3 18
Dokter Spes 8 0 8 2 16 6 3 18 6 3 18
Dokter Spes 8 0 8 2 16 6 3 18 6 3 18
Dokter Umum 7 0 7 2 14 6 3 18 6 3 18
Dokter Spes 8 0 8.0 2 16 2 3 6 4 3 12 Ka.Inst. Re
Dokter Umum 7 0 7 2 14 6 3 18 6 3 18
Dokter Umum 7 0 7 2 14 6 3 18 6 3 18
Dokter Umum 7 0 7 2 14 6 3 18 6 3 18
Dokter Umum 7 0 7 2 14 6 3 18 6 3 18
Dokter Umum 7 0 7 2 14 6 3 18 6 3 18
Dokter Spes 8 0 8 2 16 6 3 18 6 3 18
Dokter Spes 8 LPJ 0.6 8.6 2 17.2 6 3 18 6 3 18
Dokter Spes 8 LPJ + Diklat 0.8 8.8 2 17.6 6 3 18 4 3 12 Ka
Dokter Spes 8 0 8 2 16 2 3 6 2 3 6
Dokter Spes 8 0 8 2 16 6 3 18 6 3 18 KSM
Dokter Spes 8 0 8 2 16 6 3 18 6 3 18
Dokter Umum 7 0 7 2 14 6 3 18 6 3 18
Dokter Umum 7 LPJ 0.6 7.6 2 15.2 6 3 18 6 3 18
Dokter Umum 7 0 7 2 14 6 3 18 6 3 18
Dokter Umum 7 0 7 2 14 6 3 18 6 3 18
Dokter Spes 8 0 8 2 16 6 3 18 6 3 18
Dokter Spes 8 0 8 2 16 6 3 18 6 3 18
Dokter Umum 7 7 2 14 6 3 18 6 3 18
Dokter Umum 7 7 2 14 6 3 18 6 3 18
Dokter Umum 7 7 2 14 6 3 18 6 3 18

Page 61 of 248

925,771,569.00 925,771,569.00
5,241,057.50 5,241,057.50

Page 62 of 248
MBER 2017
JABATAN SAAT INI PRESTASI KERJA JUMLAH JUMLAH NOMOR TOTAL

FUNGSIONAL N B SKINERJA
ABSENSI
NILAIBASICSKOR SKOR SKOR REKENING S.INDIVIDU
POSITION INDEX (5) PERFORMANCE INDEX (6) INDIVIDU BPD PERAWAT
8 9 10 10
Direktur 10 3 30 106 4 424 532.20 - 0272906793

adir Medik 10 3 30 98 4 392 495.40 - 0272571198
Umum & Keu 10 3 30 88 4 352 452.80 - 0272119163
abag T.U 9 3 27 84 4 336 433.80 - 0272898545

mum & Perbekalan 7 3 21 94 4 376 465.20 - 0272097798
ubag PSDM 7 3 21 88 4 352 441.40 - 0272300453
bag Personalia 7 3 21 78 4 312 392.80 - 0273050141
ggota PPTK 3 3 9 90 4 360 434.80 869.60 0272300089
eriksa Barang 5 3 15 76 4 304 377.00 754.00 0272304581
ta Pengadaan 5 3 15 64 4 256 323.00 646.00 0276100513
0 3 0 72 4 288 344.40 688.80 0272302715
0 3 0 62 4 248 294.20 588.40 0272924546
0 3 0 70 4 280 329.00 658.00 0272303321
0 3 0 62 4 248 293.40 586.80 0272303614
Pengurus Barang 5 3 15 72 4 288 354.20 708.40 0272301743
0 3 0 58 4 232 274.60 549.20 0272946728
eriksa Barang 5 3 15 54 4 216 270.80 541.60 0272302073
0 3 0 58 4 232 279.80 559.60 0272509611
0 3 0 58 4 232 279.40 558.80 0272488835
ggota PPTK 3 3 9 58 4 232 288.80 577.60 0272509280
ggota PPTK 3 3 9 48 4 192 238.20 476.40 0272508909
0 3 0 54 4 216 261.40 522.80 0276100564
0 3 0 58 4 232 279.80 559.60 0272508968
0 3 0 54 4 216 261.80 523.60 0272649146
0 3 0 38 4 152 181.40 362.80 0272794545
0 3 0 52 4 208 252.80 505.60 0272975477
0 3 0 42 4 168 201.40 402.80 0272975621
0 3 0 42 4 168 201.40 402.80 0276161474
0 3 0 52 4 208 252.00 504.00 0277006995

Page 63 of 248
MBER 2017

ABSENSI
ggota PPTK 3 3 9 58 4 232 288.40 576.80 0272601763
0 3 0 50 4 200 243.00 486.00 0277026660
ag Keuangan 9 3 27 86 4 344 438.80 - 0272102449

d Ver & Prbend 7 3 21 86 4 344 435.60 - 0272943753
bag Akuntansi 7 3 21 104 4 416 515.40 - 0272946205
Pengeluaran 5 3 15 82 4 328 398.40 796.80 0272302031
gadaan Brg/Jasa 5 3 15 84 4 336 417.40 834.80 0272300526
Bend. Pengeluaran 3 3 9 64 4 256 316.60 633.20 0276214390
. Penerimaan 5 3 15 70 4 280 349.60 699.20 0272979561
mbantu PPK 3 3 9 70 4 280 344.00 688.00 0272978735
ntu Bend. Gaji 3 3 9 68 4 272 332.60 665.20 0272933677
0 3 0 58 4 232 284.60 569.20 0272503656
0 3 0 64 4 256 305.60 611.20 0276227611
u Bend. Penerima 3 3 9 66 4 264 319.60 639.20 0272993955
0 3 0 68 4 272 325.60 651.20 0272303541
0 3 0 66 4 264 316.60 633.20 0272303398
0 3 0 70 4 280 334.60 669.20 0272303479
0 3 0 62 4 248 293.00 586.00 0276006258
0 3 0 62 4 248 292.60 585.20 0272471070
0 3 0 62 4 248 298.60 597.20 0272919836
bantu PPTK 3 3 9 60 4 240 292.60 585.20 0272922489
0 3 0 58 4 232 279.80 559.60 0272456445
g Pembantu PPK 3 3 9 58 4 232 288.40 576.80 0272429430
0 3 0 58 4 232 279.40 558.80 0272509557
0 3 0 52 4 208 256.40 512.80 0272510172
0 0 0 62 4 248 299.00 598.00 0272304505
0 3 0 48 4 192 232.40 464.80 0276071688
STAF 0 3 0 58 4 232 280.20 560.40 0272509069
0 3 0 52 4 208 258.40 516.80 0272975400
0 3 0 52 4 208 252.40 504.80 0272975299
0 3 0 52 4 208 258.40 516.80 0272980250
0 3 0 54 4 216 267.80 535.60 0277026325

Page 64 of 248
MBER 2017

ABSENSI
Bid Rengram 9 3 27 102 4 408 511.20 - 0272011028

bag Sungram 7 3 21 90 4 360 450.80 - 0272302821
subag RM 7 3 21 92 4 368 460.60 - 0272302634
0 3 0 78 4 312 365.80 731.60 0272300402
0 3 0 62 4 248 297.00 594.00 0272990646
0 3 0 72 4 288 343.60 687.20 0272908664
0 3 0 66 4 264 311.00 622.00 0272303592
eriksa Barang 5 3 15 66 4 264 326.00 652.00 0272303568
Pengadaan Brg/js 5 3 15 70 4 280 348.80 697.60 0272845514
ggota PPTK 3 3 9 64 4 256 311.00 622.00 0272304181
0 3 0 64 4 256 302.00 604.00 0272303665
0 3 0 62 4 248 298.60 597.20 0272304262
0 3 0 60 4 240 284.00 568.00 0272507031
0 3 0 54 4 216 261.00 522.00 0272304611
0 3 0 56 4 224 270.00 540.00 0272794774
0 3 0 56 4 224 272.60 545.20 0272642061
0 3 0 56 4 224 272.60 545.20 0382250982
0 3 0 56 4 224 269.60 539.20 0272482543
0 3 0 68 4 272 320.40 640.80 0272301182
0 3 0 68 4 272 320.40 640.80 0272301786
ggota PPTK 3 3 9 68 4 272 329.40 658.80 0272301166
0 3 0 76 4 304 355.60 711.20 0272107556
0 3 0 50 4 200 241.40 482.80 0272509182
0 3 0 50 4 200 241.40 482.80 0272509191
ggota PPTK 3 3 9 48 4 192 238.20 476.40 0272509123
0 3 0 48 4 192 234.80 469.60 0272884374
0 3 0 48 4 192 234.40 468.80 0272509468
0 3 0 48 4 192 232.40 464.80 0272794618
0 3 0 48 4 192 235.80 471.60 0272794626
0 3 0 42 4 168 204.40 408.80 0276213415
0 3 0 46 4 184 226.40 452.80 0272980624
0 3 0 42 4 168 201.40 402.80 0316684360

Page 65 of 248
MBER 2017

ABSENSI
0 3 0 46 4 184 223.40 446.80 0277006944
0 3 0 92 4 368 439.60 879.20 0272927537
0 3 0 82 4 328 389.00 778.00 0276044681
0 3 0 70 4 280 334.60 669.20 0272301654
0 3 0 74 4 296 358.60 717.20 0272300194
0 3 0 68 4 272 325.60 651.20 0272300160
0 3 0 64 4 256 307.60 615.20 0272304271
0 3 0 68 4 272 325.60 651.20 0272301727
Staf 0 3 0 58 4 232 280.60 561.20 0272933685
0 3 0 58 4 232 281.00 562.00 0272964459
0 3 0 44 4 176 216.40 432.80 0272794782
0 3 0 52 4 208 252.00 504.00 0277019876
0 3 0 48 4 192 238.40 476.80 0276091859
0 3 0 44 4 176 216.40 432.80 0276091972
0 3 0 48 4 192 228.40 456.80 0272509204
PTK & Koord.TP2RI 4 3 12 72 4 288 360.80 721.60 0272981353
0 3 0 66 4 264 317.40 634.80 0272303410
0 3 0 54 4 216 267.80 535.60 0272649162
0 3 0 54 4 216 267.40 534.80 0272649171
0 3 0 44 4 176 216.40 432.80 0272794316
0 3 0 46 4 184 229.40 458.80 0272980721
0 3 0 42 4 168 207.40 414.80 0276224778
0 3 0 42 4 168 207.00 414.00 0277019582
0 3 0 42 4 168 207.00 414.00 0277019671
0 3 0 40 4 160 192.00 384.00 0277026350
0 3 0 44 4 176 107.00 214.00 0276365592
elayanan Medik 9 3 27 90 4 360 461.60 - 0272926794

Bid. Rawat Jalan 7 3 21 64 4 256 331.00 - 0272642087
d Rawat Darurat 7 3 21 82 4 328 415.60 - 0272300682
ggota PPTK 3 3 9 76 4 304 371.00 742.00 0272931399
0 3 0 68 4 272 320.00 640.00 0272301514
0 3 0 58 4 232 279.80 559.60 0272461848

Page 66 of 248
MBER 2017

ABSENSI
0 3 0 52 4 208 252.80 505.60 0272650411
0 3 0 52 4 208 252.40 504.80 0277006537
0 3 0 52 4 208 252.00 504.00 0277019442
Penunjang Medik 9 3 27 98 4 392 496.40 - 0273014446

Bidang Jangmed 7 3 21 84 4 336 420.60 - 0272118698
Bidang Farmasi 7 3 21 78 4 312 398.80 - 0272925976
ggota PPTK 3 3 9 60 4 240 293.00 586.00 0272924350
ggota PPTK 3 3 9 58 4 232 284.00 568.00 0272943265
ggota PPTK 3 3 9 58 4 232 288.80 577.60 0272508917
. Keperawatan 9 3 27 98 4 392 496.40 - 0272301018

d SDM dan Askep 7 3 21 86 4 344 433.60 - 0272300836
bid Rawat Inap 7 3 21 86 4 344 430.00 - 0272025517
ggota PPTK 3 3 9 68 4 272 328.60 657.20 0272303525
ggota PPTK 3 3 9 58 4 232 289.60 579.20 0272509948
Perawat 0 3 0 50 4 200 245.40 490.80 0277006855
ngadaan Brg/Jasa 9 3 27 82 4 328 418.00 836.00 0272302481

emasaran 0 3 0 78 4 312 375.00 750.00 0272302782
0 3 0 52 4 208 252.00 504.00 0277021714
0 3 0 44 4 176 214.00 428.00 0277019311
2,363,595.00
Ka. Ruangan 4 3 12 92 4 368 466.00 466.00 0272302383
Wa.Karu 0 3 0 82 4 328 413.00 413.00 0272619417
Perawat Pelaksana0 3 0 72 4 288 360.80 360.80 0272981426
0 3 0 68 4 272 323.00 323.00 0272301581
Perawat 0 3 0 52 4 208 269.20 269.20 0272509964
Perawat 0 3 0 50 4 200 259.40 259.40 0272509018

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ABSENSI
Perawat 0 3 0 52 4 208 268.80 268.80 0272509581
Perawat 0 3 0 56 4 224 291.60 291.60 0272554978
Perawat 0 3 0 48 4 192 250.80 250.80 0276071581
Perawat 0 3 0 50 4 200 259.80 259.80 0272509522
Perawat 0 3 0 52 4 208 270.40 270.40 0272978671
Perawat 0 3 0 46 4 184 241.00 241.00 0277019396
Perawat 0 3 0 48 4 192 250.00 250.00 0276027174
0 3 0 44 4 176 232.00 232.00 0277026538
Perawat 0 3 0 44 4 176 232.00 232.00 0277033402
Perawat 0 3 0 44 4 176 232.00 232.00 0277033445
4,962.20
27,531,910.25
Ka.Ruangan 3 3 9 90 4 360 451.60 451.60 0272302081
Bidan Penyelia 0 3 0 92 4 368 452.40 452.40 0272924759
Bidan Pelak. Lanjutan
0 3 0 72 4 288 361.60 361.60 0272981434
Bidan Pelaksana 0 3 0 68 4 272 343.60 343.60 0272303118
0 3 0 70 4 280 331.60 331.60 0272301701
0 3 0 50 4 200 238.00 238.00 0272304190
0 3 0 68 4 272 344.00 344.00 0272991413
0 3 0 68 4 272 342.80 342.80 0272941505
0 3 0 70 4 280 332.00 332.00 0272301638
0 3 0 52 4 208 269.20 269.20 0092166422
Bidan Pelaksana 0 3 0 52 4 208 270.00 270.00 0272509174
Bidan Pelaksana 0 3 0 52 4 208 270.00 270.00 0272509336
Bidan Pelaksana 0 3 0 50 4 200 261.00 261.00 0272967784
Bidan Pelaksana 0 3 0 52 4 208 269.60 269.60 0272509671
Bidan Pelaksana 0 3 0 58 4 232 297.80 297.80 0272640271
Bidan Pelaksana 0 3 0 56 4 224 288.40 288.40 0272640289
Bidan Pelaksana 0 3 0 50 4 200 260.60 260.60 0272499012
Bidan Pelaksana 0 3 0 50 4 200 260.60 260.60 0272510563
Bidan Pelaksana 0 3 0 48 4 192 251.20 251.20 0272794243
Bidan Pelaksana 0 3 0 48 4 192 251.60 251.60 0272649189
Bidan Pelaksana 0 3 0 50 4 200 260.20 260.20 0272486697
Bidan Pelaksana 0 3 0 48 4 192 251.20 251.20 0276100572

Page 68 of 248
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ABSENSI
Bidan Pelaksana 0 3 0 48 4 192 251.20 251.20 0272794651
Bidan Pelaksana 0 3 0 46 4 184 242.20 242.20 0276235460
Bidan 0 3 0 46 4 184 241.00 241.00 0277017075
Bidan 0 3 0 46 4 184 241.00 241.00 0277019591
Bidan 0 3 0 46 4 184 241.80 241.80 0276227629
Bidan 0 3 0 46 4 184 241.80 241.80 0277019507
8,118.00
30,447,114.75
Ka. Ruangan 3 3 9 98 4 392 507.00 507.00 0273012915
Wakaru 0 3 0 88 4 352 453.60 453.60 0272302502
Perawat Pelaks.Lanj.0 3 0 82 4 328 424.20 424.20 0272300909
Pekarya 0 3 0 68 4 272 323.00 323.00 0272301697
Perawat 0 3 0 50 4 200 272.20 272.20 0272509760
0 3 0 40 4 160 191.40 191.40 0272509271
Perawat 0 3 0 50 4 200 271.80 271.80 0272506281
Bidan 0 3 0 54 4 216 291.80 291.80 0276092014
Bidan 0 3 0 48 4 192 262.40 262.40 0276092057
Bidan 0 3 0 48 4 192 262.80 262.80 0276092049
Perawat 0 3 0 54 4 216 293.80 293.80 0276071602
Bidan 0 3 0 48 4 192 262.40 262.40 0272794561
Perawat 0 3 0 44 4 176 244.00 244.00 0277033267
Perawat 0 3 0 44 4 176 244.00 244.00 0277033364
Perawat 0 3 0 50 4 200 275.00 275.00 0277033372
Perawat 0 3 0 44 4 176 244.00 244.00 0277033178
8,027.80

Page 69 of 248
MBER 2017

ABSENSI
15,810,492.75
Ka.Ruangan 3 3 9 102 4 408 512.00 512.00 0272304017
Perawat Muda 0 3 0 60 4 240 309.60 309.60 0277000156
Perawat Pelaks. Pemula
0 3 0 64 4 256 320.00 320.00 0272303207
Pembantu Perawat0 3 0 70 4 280 332.00 332.00 0272517088
perawat 0 3 0 56 4 224 288.40 288.40 0272642028
Perawat 0 3 0 52 4 208 269.20 269.20 0272900817
Perawat 0 3 0 52 4 208 269.20 269.20 0272509361
Perawat 0 3 0 50 4 200 259.80 259.80 0272509867
Perawat 0 3 0 50 4 200 259.80 259.80 0272509301
0 3 0 40 4 160 191.40 191.40 0272509751
Perawat 0 3 0 50 4 200 259.80 259.80 0272510598
0 3 0 46 4 184 241.00 241.00 0276028677
0 3 0 46 4 184 241.00 241.00 0277006987
0 3 0 52 4 208 270.80 270.80 0272995532
Perawat 0 3 0 46 4 184 241.00 241.00 0277019329
Perawat 0 3 0 46 4 184 241.00 241.00 0277019299
Perawat 0 3 0 46 4 184 241.00 241.00 0277019361
Perawat 0 3 0 44 4 176 232.00 232.00 0277033241
Perawat 0 3 0 44 4 176 232.00 232.00 0277033381
6,052.20
20,696,117.00
Ka. Ruangan 3 3 9 106 4 424 529.60 529.60 0277026694
Wakaru 0 3 0 88 4 352 435.20 435.20 0272304076
Perawat 0 3 0 52 4 208 269.20 269.20 0272509999
Perawat 0 3 0 52 4 208 269.20 269.20 0272459525
Perawat 0 3 0 52 4 208 269.20 269.20 0272510326
0 3 0 40 4 160 191.40 191.40 0272509956

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ABSENSI
Perawat 0 3 0 52 4 208 268.80 268.80 0272509638
Perawat 0 3 0 52 4 208 268.80 268.80 0272510130
Perawat 0 3 0 52 4 208 268.80 268.80 0272509875
Perawat 0 3 0 52 4 208 268.80 268.80 0272510296
Perawat 0 3 0 54 4 216 281.40 281.40 0272794642
Perawat 0 3 0 46 4 184 241.80 241.80 0272992151
Perawat 0 3 0 46 4 184 241.00 241.00 0277006952
Perawat 0 3 0 46 4 184 241.40 241.40 0277006910
Perawat 0 3 0 46 4 184 241.00 241.00 0277019302
Perawat 0 3 0 46 4 184 241.00 241.00 0277019493
Perawat 0 3 0 50 4 200 263.00 263.00 0277026511
Perawat 0 3 0 50 4 200 263.00 263.00 0277026457
Perawat 0 3 0 44 4 176 232.00 232.00 0277026465
Perawat 0 3 0 44 4 176 232.00 232.00 0277026368
Perawat 0 3 0 44 4 176 232.00 232.00 0277026481
Perawat 0 3 0 44 4 176 232.00 232.00 0277026503
Perawat 0 3 0 44 4 176 232.00 232.00 0802039239
Perawat 0 3 0 50 4 200 263.00 263.00 0277033160
7,464.80
12,964,105.38
Perawat Muda 0 3 0 86 4 344 430.20 430.20 0272302260
Perawat 0 3 0 64 4 256 324.80 324.80 0272303240
Perawat 0 3 0 50 4 200 259.40 259.40 0272510181
Perawat 0 3 0 46 4 184 241.00 241.00 0692089251
0 3 0 52 4 208 270.40 270.40 0272995648
Perawat 0 3 0 46 4 184 241.00 241.00 0277006898
0 3 0 68 4 272 323.00 323.00 0272301603
Perawat 0 3 0 54 4 216 281.40 281.40 0272794588
Perawat 0 3 0 50 4 200 263.00 263.00 0286407404
Perawat 0 3 0 44 4 176 232.00 232.00 0277033224
Perawat 0 3 0 44 4 176 232.00 232.00 0277033330

Page 71 of 248
MBER 2017

ABSENSI
Perawat 0 3 0 44 4 176 232.00 232.00 0277033321
Perawat 0 3 0 44 4 176 232.00 232.00 0277033500
4,563.20
8,022,927.25
Ka. Ruangan 3 3 9 90 4 360 458.00 458.00 0272301085
Perawat Pelaks.Lanj3 3 9 80 4 320 413.80 413.80 0272302511
0 3 0 68 4 272 342.80 342.80 0272303126
Perawat 0 3 0 50 4 200 260.20 260.20 0272516502
Perawat 0 3 0 50 4 200 260.20 260.20 0272554765
Perawat 0 3 0 52 4 208 269.20 269.20 0272510423
0 3 0 42 4 168 202.40 202.40 0272991324
Perawat 0 3 0 46 4 184 241.40 241.40 0276071653
Perawat 0 3 0 48 4 192 250.40 250.40 0272794669
Perawat 0 3 0 48 4 192 250.40 250.40 0272794677
Perawat 0 3 0 52 4 208 268.80 268.80 0272487537
Perawat 0 3 0 54 4 216 281.40 281.40 0272794693
Perawat 0 3 0 46 4 184 241.00 241.00 0272978778
Perawat 0 3 0 46 4 184 241.00 241.00 0277006928
Perawat 0 3 0 46 4 184 241.00 241.00 0277017083
Perawat 0 3 0 46 4 184 241.00 241.00 0277006961
Perawat 0 3 0 46 4 184 241.00 241.00 0277006863
9,485.20
3,316,930.50
Perawat 0 3 0 52 4 208 268.80 268.80 0272509221
Perawat 0 3 0 52 4 208 269.20 269.20 0272248222
Perawat 0 3 0 52 4 208 269.20 269.20 0272881812
Perawat 0 3 0 52 4 208 269.20 269.20 0272509891
Perawat 0 3 0 50 4 200 263.00 263.00 0277026449
Perawat 0 3 0 50 4 200 263.00 263.00 0282147068

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ABSENSI
Perawat 0 3 0 44 4 176 232.00 232.00 0277026414
Perawat 0 3 0 50 4 200 263.00 263.00 0277033305
Perawat 0 3 0 50 4 200 263.00 263.00 0277034166
2,721.20
Ka. Ruangan 3 3 9 94 4 376 478.40 478.40 0272300585

Perawat 0 3 0 52 4 208 268.80 268.80 0272886784
Perawat 0 3 0 46 4 184 241.80 241.80 0276071661
Perawat 0 3 0 52 4 208 269.20 269.20 0272509743
Perawat 0 3 0 52 4 208 268.80 268.80 0272460167
Perawat 0 3 0 46 4 184 241.00 241.00 0277019418
Perawat 0 3 0 50 4 200 263.00 263.00 0277026376
Perawat 0 3 0 44 4 176 232.00 232.00 0277026392
Perawat 0 3 0 50 4 200 263.00 263.00 0277027119
0 3 0 40 4 160 191.40 191.40 0272489530
Perawat 0 3 0 44 4 176 232.00 232.00 0277033127
15,544,681.75
Ka Poli 3 3 9 90 4 360 457.20 457.20 0272302570
Perawat 0 3 0 56 4 224 288.40 288.40 0272642010
Perawat 0 3 0 50 4 200 259.40 259.40 0272509972
Perawat 0 3 0 52 4 208 269.20 269.20 0272509654
0 3 0 40 4 160 191.40 191.40 0272509263
Perawat 0 3 0 50 4 200 259.80 259.80 0272559074
Perawat 0 3 0 50 4 200 259.80 259.80 0272510121
Perawat 0 3 0 48 4 192 250.40 250.40 0276071599
Perawat 0 3 0 46 4 184 241.40 241.40 0272978611
Perawat 0 3 0 46 4 184 241.00 241.00 0272991871
Perawat 0 3 0 50 4 200 263.00 263.00 0286820441

Page 73 of 248
MBER 2017

ABSENSI
Perawat 0 3 0 44 4 176 232.00 232.00 0277027143
Perawat 0 3 0 50 4 200 263.00 263.00 0277033151
Perawat 0 3 0 44 4 176 232.00 232.00 0277033283
Perawat 0 3 0 44 4 176 232.00 232.00 0277033259
4,930.20
11,414,029.25
Karu 3 3 9 90 4 360 468.40 468.40 0272300801
Wakaru 0 3 0 88 4 352 439.20 439.20 0272300810
0 3 0 40 4 160 191.40 191.40 0272509719
Perawat 0 3 0 56 4 224 296.40 296.40 0272554773
Perawat 0 3 0 52 4 208 275.20 275.20 0272509115
Perawat 0 3 0 52 4 208 274.80 274.80 '0272883734
Perawat 0 3 0 52 4 208 274.80 274.80 0272511713
Perawat 0 3 0 46 4 184 247.40 247.40 0277019132
Perawat 0 3 0 46 4 184 247.00 247.00 0277019281
Perawat 0 3 0 44 4 176 238.00 238.00 0882021700
Perawat 0 3 0 44 4 176 238.00 238.00 0277027127
Perawat 0 3 0 44 4 176 238.00 238.00 0277033216
Perawat 0 3 0 44 4 176 238.00 238.00 0632060831
4,937.00
10,600,902.00
Ka. Ruangan 3 3 9 88 4 352 448.20 448.20 0272301549
Perawat 0 3 0 60 4 240 307.20 307.20 0277019728
Perawat 0 3 0 52 4 208 268.80 268.80 0272882754
Perawat 0 3 0 50 4 200 259.80 259.80 0272509590
Perawat 0 3 0 50 4 200 259.40 259.40 0272516723
Perawat 0 3 0 50 4 200 259.80 259.80 0272554749

Page 74 of 248
MBER 2017

ABSENSI
Perawat 0 3 0 46 4 184 241.40 241.40 0276108581
Perawat 0 3 0 46 4 184 241.40 241.40 0277006901
Perawat 0 3 0 46 4 184 241.00 241.00 0277019124
Perawat 0 3 0 46 4 184 241.00 241.00 0277019400
Perawat 0 3 0 50 4 200 263.00 263.00 0277026406
Perawat 0 3 0 44 4 176 232.00 232.00 0277026473
Perawat 0 3 0 44 4 176 232.00 232.00 0277033275
Perawat 0 3 0 46 4 184 241.00 241.00 0277006871
Perawat 0 3 0 50 4 200 263.00 263.00 0282147122
0 3 0 42 4 168 202.40 202.40 0272982791
5,198.00
69,604,450.80
Ka.Ruang 3 3 9 102 4 408 521.60 521.60 0272302324
Perawat Penyelia 0 3 0 92 4 368 457.20 457.20 0272302235
Bidan Penyelia 0 3 0 90 4 360 453.40 453.40 0272303347
Bidan Pelaksana 0 3 0 58 4 232 308.60 308.60 0272509573
Perawat 0 3 0 62 4 248 326.60 326.60 0272536333
0 3 0 48 4 192 231.40 231.40 0272509212

Page 75 of 248
MBER 2017

ABSENSI
0 3 0 48 4 192 231.40 231.40 0272558094
0 3 0 48 4 192 231.40 231.40 0522054119
0 3 0 42 4 168 202.40 202.40 0272873721
Perawat 0 3 0 52 4 208 280.40 280.40 0272872155
Perawat 0 3 0 56 4 224 305.60 305.60 0272509506
Perawat 0 3 0 46 4 184 253.40 253.40 0272649545
Perawat 0 3 0 46 4 184 253.40 253.40 0952011545
Perawat 0 3 0 44 4 176 244.40 244.40 0277026520
10,452.60
25,220,030.57
Ka.Ruang 5 3 15 102 4 408 527.20 527.20 0272301867
5,453.20
Ka USS 5 3 15 78 4 312 393.80 787.60 0272974144

Pemeriksa Barang5 3 15 66 4 264 327.80 655.60 0272894990
0 3 0 42 4 168 204.00 408.00 0277019647
0 3 0 42 4 168 204.00 408.00 0277019531
0 3 0 42 4 168 204.00 408.00 0277019604
23,983,407.50
Ka.ICU 3 3 9 82 4 328 427.60 427.60 0272301816

Page 76 of 248
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ABSENSI
Wakaru Ruang ICU0 3 0 82 4 328 424.60 424.60 0272302456
Pembantu perawat0 3 0 70 4 280 332.40 332.40 0272303576
Perawat 0 3 0 52 4 208 281.60 281.60 0272509433
Perawat 0 3 0 52 4 208 281.20 281.20 0272509352
Perawat 0 3 0 50 4 200 272.20 272.20 0272509930
Perawat 0 3 0 50 4 200 271.80 271.80 0272554722
Perawat 0 3 0 52 4 208 281.20 281.20 0272509646
0 3 0 46 4 184 254.60 254.60 0277006880
Perawat 0 3 0 50 4 200 275.00 275.00 0277033186
Perawat 0 3 0 50 4 200 275.00 275.00 0277033206
Perawat 0 3 0 44 4 176 244.00 244.00 0277033194
Perawat 0 3 0 44 4 176 244.00 244.00 0277033437
7,844.40
30,910,766.25
Ka.Ruangan 3 3 9 84 4 336 435.80 435.80 0272304670
Bidan Pelaksana 0 3 0 68 4 272 356.00 356.00 0272924619

Page 77 of 248
MBER 2017

ABSENSI
0 3 0 48 4 192 231.40 231.40 0272510148
Perawat 0 3 0 50 4 200 271.40 271.40 0272554731
Perawat 0 3 0 48 4 192 262.40 262.40 0276092081
0 3 0 64 4 256 304.60 304.60 0272304131
0 3 0 48 4 192 231.40 231.40 0272845131
Bidan 0 3 0 56 4 224 301.20 301.20 0272832579
Perawat 0 3 0 50 4 200 271.40 271.40 0272238928
Perawat 0 3 0 50 4 200 271.80 271.80 0272509841
Perawat 0 3 0 54 4 216 291.80 291.80 0272794707
Perawat 0 3 0 48 4 192 262.40 262.40 0272794731
Perawat 0 3 0 48 4 192 262.80 262.80 0276071645
0 3 0 42 4 168 204.40 204.40 0272995575
0 3 0 58 4 232 282.40 282.40 0272863024
Bidan 0 3 0 46 4 184 253.80 253.80 0276227637
Bidan 0 3 0 46 4 184 253.80 253.80 0276192931
Perawat 0 3 0 52 4 208 281.20 281.20 0272509298
Perawat 0 3 0 50 4 200 271.80 271.80 0272554781
Perawat 0 3 0 50 4 200 271.80 271.80 0272554757
Perawat 0 3 0 48 4 192 262.40 262.40 0272794723
Perawat 0 3 0 46 4 184 253.40 253.40 0272980063
Perawat 0 3 0 52 4 208 282.40 282.40 0272995796
Perawat 0 3 0 46 4 184 253.00 253.00 0277019345
Perawat 0 3 0 46 4 184 253.00 253.00 0276028375
Perawat 0 3 0 46 4 184 253.00 253.00 0277019272
Bidan Pelaksana 0 3 0 52 4 208 282.40 282.40 0272488193
Bidan Pelaksana 0 3 0 48 4 192 263.20 263.20 0276100521
Bidan Pelaksana 0 3 0 48 4 192 262.80 262.80 0272794600
Bidan Pelaksana 0 3 0 48 4 192 262.80 262.80 0272794464
Bidan Pelaksana 0 3 0 54 4 216 292.20 292.20 0272490872
Perawat 0 3 0 46 4 184 253.00 253.00 0277019388

Page 78 of 248
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ABSENSI
Perawat 0 3 0 50 4 200 271.80 271.80 0272486417
Perawat 0 3 0 44 4 176 244.00 244.00 0882019845
13,341.60
91,455,000.00
Ka.Ruang 3 3 9 78 4 312 406.80 406.80 0272301808
Perawat pelaksana0 3 0 78 4 312 395.40 395.40 0272305277
Perawat 0 3 0 64 4 256 325.60 325.60 0272963835
Perawat 0 3 0 50 4 200 261.40 261.40 0272509662
0 3 0 46 4 184 222.40 222.40 0272509727
Perawat 0 3 0 48 4 192 252.80 252.80 0276100556
4,726.60
2,796,570.60
Ka.Poli Indoscopi 3 3 9 94 4 376 471.60 471.60 0272300887
0 3 0 46 4 184 222.40 222.40 0272497541
1,432.40
342,062.50
Ka Poli 3 3 9 90 4 360 438.40 438.40 0272302537
Perawat 0 3 0 54 4 216 267.40 267.40 0272794570
705.80
127,400.00
Ka Poli 3 3 9 68 4 272 339.40 339.40 0272924376
339.40
1,626,769.61
Ka.Ruangan 3 3 9 94 4 376 470.40 470.40 0272301093

Page 79 of 248
MBER 2017

ABSENSI
Perawat Pelak 0 3 0 68 4 272 336.40 336.40 0272305480
1,580.60
1,151,312.50
Perawat 0 3 0 52 4 208 257.20 257.20 0272509883
682.40
3,358,745.00
Ka.Poli 3 3 9 96 4 384 472.60 472.60 0272304297
1,571.40
3,265,711.20
Ka Poli 3 3 9 88 4 352 435.00 435.00 0272300771
Perawat Pelaks. Lanj.
0 3 0 76 4 304 366.40 366.40 0272302286
Bidan Pelaksana 0 3 0 58 4 232 285.00 285.00 0272507236
2,480.40
2,069,736.50
Ka. Poli 3 3 9 94 4 376 460.80 460.80 0272302171
1,498.20
2,753,237.50
Ka. Poli Jantung 3 3 9 92 4 368 447.80 447.80 0272300828
0 3 0 76 4 304 366.00 366.00 0272301212
Perawat 0 3 0 66 4 264 322.20 322.20 0272990760

Page 80 of 248
MBER 2017

ABSENSI
1,467.60
4,531,161.25
Ka. Poli Mata 3 3 9 88 4 352 430.60 430.60 0272300712
Staf 0 3 0 68 4 272 329.60 329.60 0272304688
Staf 0 3 0 56 4 224 275.60 275.60 0372114592
Staf 0 3 0 52 4 208 256.40 256.40 0272509344
Staf 0 3 0 70 4 280 - -
0 3 0 44 4 176 220.00 220.00 0277011484

1,842.60
668,947.50
Bidan Penyelia 3 3 9 92 4 368 448.60 448.60 0272302618
Bidan Penyelia 0 3 0 90 4 360 428.60 428.60 0272880859
877.20
1,534,617.50
Bidan Penyelia 3 3 9 94 4 376 458.40 458.40 0273006231
Bidan Pelaksana 0 3 0 82 4 328 395.00 395.00 0272304556
853.40
209,300.00
Ka Poli KK 3 3 9 88 4 352 434.20 434.20 0272300569
765.00
4,415,816.25
Ka Poli Gigi 3 3 9 84 4 336 411.40 411.40 0272302219
0 3 0 42 4 168 204.40 204.40 0277006545
Perawat Gigi 0 3 0 46 4 184 229.00 229.00 0277006936
1,170.00
367,087.50
Ka. Poli 3 3 9 106 4 424 516.80 516.80 0272302251
0 3 0 84 4 336 402.40 402.40 0272301719
1,233.20
438,587.50

Page 81 of 248
MBER 2017

ABSENSI
Ka.Poli Paru 3 3 9 94 4 376 457.60 457.60 0272300691
0 3 0 60 4 240 292.80 292.80 0272981795
750.40
22,912.50
Perawat 0 3 0 46 4 184 229.00 229.00 0277019353
0 3 0 50 4 200 249.00 249.00 0372163518
816.60
15,190,175.00
Ka.Poli Rehab M 3 3 9 90 4 360 440.40 440.40 0272302057
Pelaksana Fisoterapi0 3 0 68 4 272 332.80 332.80 0272978603
0 3 0 52 4 208 256.80 256.80 0272507601
0 3 0 48 4 192 238.40 238.40 0276071629
0 3 0 48 4 192 238.40 238.40 0276071637
0 3 0 44 4 176 213.40 213.40 0272794804
0 3 0 52 4 208 255.40 255.40 0272980438
0 3 0 46 4 184 229.40 229.40 0277000148
3,004.80
3,422,500.00
Laborat Kes.Pelaks.0 3 0 56 4 224 275.60 275.60 0272640246
0 3 0 44 4 176 220.00 220.00 0277033470
772.80
702,975.00
Nutrisionis Penyelia3 3 9 88 4 352 434.60 434.60 0272119155 434.60
187,200.00
Ka Ruang 3 3 9 68 4 272 361.00 361.00 0272301921
0 3 0 62 4 248 314.60 314.60 0272303428
0 3 0 52 4 208 274.40 274.40 0272509239
0 3 0 52 4 208 274.40 274.40 0272509689

Page 82 of 248
MBER 2017

ABSENSI
0 3 0 44 4 176 234.80 234.80 0272649201
0 3 0 42 4 168 225.40 225.40 0272980136
1,684.60
7,782,192.38
Pemeriksa Bara 5 3 15 84 4 336 437.40 437.40 0272301735
adiografer Pelaks. Lanj.
0 3 0 66 4 264 340.20 340.20 0272978239
eriksa Barang 5 3 15 70 4 280 373.20 373.20 0272303177
0 3 0 68 4 272 350.80 350.80 0272943991
0 3 0 74 4 296 376.60 376.60 0272303185
Radiografer Pelaksana
0 3 0 62 4 248 321.00 321.00 0272965986
0 3 0 60 4 240 312.00 312.00 0272592551
0 3 0 60 4 240 312.00 312.00 0272589305
Administrasi 0 3 0 70 4 280 340.20 340.20 0272303703
Administrasi 0 3 0 52 4 208 257.20 257.20 0272924678
0 3 0 62 4 248 303.00 303.00 0272300054
0 3 0 46 4 184 247.40 247.40 0277000091
0 3 0 46 4 184 247.00 247.00 0277019540
0 3 0 44 4 176 - - 0277026724
4,218.00
27,175,494.06
Ka.Ruang 3 3 9 92 4 368 460.60 460.60 0272118787
eriksa Barang 5 3 15 94 4 376 476.80 476.80 0272052298
aborat Kes.Pelaks.Lanj
0 3 0 80 4 320 396.40 396.40 0272302090
Administrasi 0 3 0 54 4 216 267.00 267.00 0272927031

Page 83 of 248
MBER 2017

ABSENSI
0 3 0 52 4 208 268.40 268.40 0272509107
0 3 0 52 4 208 268.40 268.40 0272508941
0 3 0 50 4 200 259.40 259.40 0272508933
0 3 0 50 4 200 259.80 259.80 0322693451
0 3 0 46 4 184 241.40 241.40 0276092031
0 3 0 46 4 184 241.40 241.40 0276092022
0 3 0 46 4 184 241.40 241.40 0272980039
0 3 0 46 4 184 241.00 241.00 0277019566
0 3 0 46 4 184 241.00 241.00 0277019698
0 3 0 42 4 168 213.00 213.00 0277019558
0 3 0 44 4 176 232.00 232.00 0277027275
0 3 0 44 4 176 232.00 232.00 0277026384
Laborat Kes.Penyelia
0 3 0 82 4 328 409.80 409.80 0272302651
0 3 0 50 4 200 260.60 260.60 0272516511
0 3 0 48 4 192 251.60 251.60 0276092065
0 3 0 46 4 184 241.80 241.80 0282069008
0 3 0 44 4 176 232.00 232.00 0277033348
9,650.40
Ka.Instalasi 5 3 15 96 4 384 481.80 963.60 0272300321

Nutrisionis Pen 5 3 15 94 4 376 465.20 930.40 0272300178
ionis Penyelia 0 3 0 88 4 352 426.00 852.00 0272302669
eriksa Barang 5 3 15 90 4 360 446.80 893.60 0272300330
ionis Penyelia 0 3 0 82 4 328 394.60 789.20 0272304904
ionis Penyelia 0 3 0 84 4 336 404.40 808.80 0272302677
nis Pelaks.lanjt 0 3 0 66 4 264 324.20 648.40 0272857377
onis Pelaksana 0 3 0 68 4 272 330.00 660.00 0272924538
0 3 0 72 4 288 344.00 688.00 0272302791
0 3 0 64 4 256 308.00 616.00 0272301956
0 3 0 68 4 272 326.00 652.00 0272303312
0 3 0 68 4 272 328.80 657.60 0272301522

Page 84 of 248
MBER 2017

ABSENSI
0 3 0 60 4 240 290.40 580.80 0272925046
0 3 0 54 4 216 261.00 522.00 0272927201
0 3 0 54 4 216 261.40 522.80 0272925020
0 3 0 54 4 216 259.00 518.00 0272303282
0 3 0 54 4 216 259.40 518.80 0272300364
0 3 0 50 4 200 241.00 482.00 0272471088
0 3 0 54 4 216 261.00 522.00 0272926671
0 3 0 50 4 200 243.00 486.00 0272964688
0 3 0 46 4 184 227.80 455.60 272,509,441
0 3 0 46 4 184 227.80 455.60 0272513911
0 3 0 48 4 192 235.20 470.40 0272509140
0 3 0 48 4 192 234.80 469.60 0272509166
0 3 0 48 4 192 234.80 469.60 0272509255
0 3 0 46 4 184 225.80 451.60 0272898561
0 3 0 46 4 184 225.40 450.80 0272509158
0 3 0 46 4 184 225.80 451.60 0272509131
0 3 0 46 4 184 225.80 451.60 0272509603
0 3 0 48 4 192 238.80 477.60 0276091867
0 3 0 44 4 176 216.80 433.60 0276091891
0 3 0 44 4 176 216.80 433.60 0276091875
0 3 0 42 4 168 207.80 415.60 0277000202
0 3 0 52 4 208 258.00 516.00 0277019515
0 3 0 46 4 184 229.00 458.00 0272944768
0 3 0 48 4 192 234.40 468.80 0272509697
0 3 0 44 4 176 220.00 440.00 1746012931
0 3 0 44 4 176 220.00 440.00 0277033399
0 3 0 44 4 176 220.00 440.00 0322855231
Pemeriksa Barang5 3 15 66 4 264 346.80 693.60 0272845409

eriksa Barang 5 3 15 62 4 248 320.40 640.80 0272305111
0 3 0 60 4 240 296.00 592.00 0272934941
eriksa Barang 5 3 15 60 4 240 310.60 621.20 0272934932
0 3 0 48 4 192 237.60 475.20 0272304572

Page 85 of 248
MBER 2017

ABSENSI
eriksa Barang 5 3 15 56 4 224 298.20 596.40 0272635579
eriksa Barang 5 3 15 56 4 224 299.00 598.00 0276161199
Pengurus Barang 5 3 15 58 4 232 308.40 616.80 0272459266
0 3 0 50 4 200 253.40 506.80 0272508976
0 3 0 44 4 176 222.40 444.80 0276091981
0 3 0 48 4 192 244.40 488.80 0276091999
0 3 0 48 4 192 245.20 490.40 0272794308
0 3 0 42 4 168 213.40 426.80 0276006193
0 3 0 42 4 168 213.40 426.80 0276006207
0 3 0 46 4 184 235.40 470.80 0272980675
0 3 0 40 4 160 192.00 384.00 0277026431
0 3 0 40 4 160 192.00 384.00 0277007002
0 3 0 40 4 160 192.00 384.00 0277026422
0 3 0 40 4 160 192.00 384.00 0277020017
0 3 0 44 4 176 214.00 428.00 0277033488
0 3 0 44 4 176 214.00 428.00 0277033496
5 3 15 90 4 360 459.20 918.40 0272300291

ndry 3 3 9 94 4 376 476.80 953.60 0272302685
ggota PPTK 3 3 9 76 4 304 391.00 782.00 0272979201
ggota PPTK 3 3 9 66 4 264 346.40 692.80 0272845522
0 3 0 74 4 296 364.60 729.20 0272302766
0 3 0 62 4 248 310.60 621.20 0272926573
0 3 0 64 4 256 319.60 639.20 0272302731
0 3 0 60 4 240 299.60 599.20 0272301981
0 3 0 54 4 216 272.60 545.20 0272990697
0 3 0 54 4 216 270.60 541.20 0272924724
0 3 0 48 4 192 225.60 451.20 0272926654
0 3 0 50 4 200 255.00 510.00 0272965064
0 3 0 48 4 192 246.40 492.80 0272509425
0 3 0 48 4 192 246.40 492.80 0272508950
0 3 0 68 4 272 337.60 675.20 0272301107
0 3 0 56 4 224 280.40 560.80 0272300461

Page 86 of 248
MBER 2017

ABSENSI
0 3 0 62 4 248 311.00 622.00 0272924694
0 3 0 52 4 208 264.40 528.80 0272924775
0 3 0 44 4 176 232.00 464.00 0277033313
0 3 0 44 4 176 232.00 464.00 0277033356
0 3 0 44 4 176 232.00 464.00 0277033453
Ka Instalasi 5 3 15 78 4 312 395.60 395.60 0272956961

Ass. Apoteker 0 3 0 92 4 368 434.00 434.00 0272302863
Ass. Apoteker Penyelia
0 3 0 84 4 336 401.60 401.60 0272304793
Apoteker 0 3 0 68 4 272 342.40 342.40 0272583404
Apoteker 0 3 0 68 4 272 334.80 334.80 0272571686
Ass. Apt. Pelaks. Lanj.
0 3 0 80 4 320 386.40 386.40 0272302847
0 3 0 76 4 304 361.60 361.60 0272303941
0 3 0 76 4 304 368.00 368.00 0272302880
Pengurus Barang 5 3 15 68 4 272 345.40 345.40 0272932646
Ass. Apoteker Pelaks.
0 3 0 68 4 272 325.60 325.60 0272974152
0 3 0 60 4 240 296.00 296.00 0272942056
0 3 0 64 4 256 308.00 308.00 0273014314
Ass.Apt Pelaksana0 3 0 64 4 256 313.60 313.60 0272926093
eriksa Barang 5 3 15 62 4 248 320.00 320.00 0272926697
eriksa Barang 5 3 15 58 4 232 292.60 292.60 0272960020
Administrasi 0 3 0 58 4 232 278.00 278.00 0272943915
Administrasi 0 3 0 58 4 232 277.60 277.60 0272926034
Administrasi 0 3 0 58 4 232 278.00 278.00 0272925941
eriksa Barang 5 3 15 58 4 232 299.60 299.60 0272642141

Page 87 of 248
MBER 2017

ABSENSI
Administrasi 0 3 0 54 4 216 261.00 261.00 0272302022
Administrasi 0 3 0 56 4 224 272.00 272.00 0272507287
Apoteker 0 3 0 58 4 232 287.40 287.40 0272498458
Apoteker 0 3 0 58 4 232 287.80 287.80 0272487545
Ass.Apt 0 3 0 50 4 200 247.40 247.40 0272510351
Ass.Apt 0 3 0 50 4 200 247.40 247.40 0272516405
Administrasi 0 3 0 48 4 192 234.40 234.40 0272509085
Ass.Apt 0 3 0 48 4 192 240.40 240.40 0272509093
Ass.Apt 0 3 0 48 4 192 234.40 234.40 0272488207
Ass.Apt 0 3 0 50 4 200 247.40 247.40 0272510318
Ass.Apt 0 3 0 44 4 176 216.40 216.40 0276006177
Ass.Apt 0 3 0 44 4 176 222.40 222.40 0272794049
Ass.Apt 0 3 0 44 4 176 216.40 216.40 0272794341
Ass.Apt 0 3 0 44 4 176 216.40 216.40 0272794634
Ass.Apt 0 3 0 44 4 176 216.40 216.40 0272936226
Farm-Klin 0 3 0 54 4 216 277.40 277.40 0277010429
Apoteker 0 3 0 52 4 208 260.00 260.00 0277019574
Apoteker 0 3 0 52 4 208 266.40 266.40 0277019523
Apoteker 0 3 0 50 4 200 257.00 257.00 0277026635
Apoteker 0 3 0 50 4 200 257.00 257.00 0277033411
Apoteker 0 3 0 50 4 200 257.00 257.00 0277033429
Ass.Apt 0 3 0 50 4 200 247.40 247.40 0277033291
Ass.Apt 0 3 0 50 4 200 247.40 247.40 0886024916
14,702.00
Anggota Peng 5 3 15 74 4 296 382.00 764.00 0272955778

m Pengadaan 7 3 21 68 4 272 361.80 723.60 0272925950
0 3 0 66 4 264 326.60 653.20 0273011374
0 3 0 58 4 232 286.60 573.20 0272963983
0 3 0 58 4 232 286.60 573.20 0277019370
0 3 0 58 4 232 286.60 573.20 0272971463
eriksa Barang 5 3 15 56 4 224 297.80 595.60 0272642079
0 3 0 68 4 272 331.60 663.20 0272301590

Page 88 of 248
MBER 2017

ABSENSI
0 3 0 58 4 232 288.60 577.20 0272567212
0 3 0 58 4 232 291.40 582.80 0272493511
0 3 0 48 4 192 242.40 484.80 0272509328
0 3 0 46 4 184 235.40 470.80 0272993599
0 3 0 46 4 184 235.40 470.80 0272993793
0 3 0 52 4 208 264.40 528.80 0277000377
0 3 0 46 4 184 235.00 470.00 0277006529
0 3 0 54 4 216 273.40 546.80 0276100530
3RS 5 3 15 66 4 264 335.20 670.40 0272955310

eriksa Barang 5 3 15 90 4 360 446.00 892.00 0272300275
0 3 0 46 4 184 223.40 446.80 0277019868
0 3 0 78 4 312 377.00 377.00 0272300313

0 3 0 66 4 264 323.00 323.00 0272925984
0 3 0 62 4 248 305.00 305.00 0272300348
0 3 0 64 4 256 314.00 314.00 0272301832
0 3 0 64 4 256 315.60 315.60 0272303673
0 3 0 58 4 232 287.40 287.40 0272989451
0 3 0 58 4 232 287.00 287.00 0272954712
0 3 0 36 4 144 184.40 184.40 0276235397
0 3 0 62 4 248 301.00 602.00 0272305234

0 3 0 54 4 216 261.00 522.00 0272304777
0 3 0 50 4 200 240.60 481.20 0272924651
0 3 0 48 4 192 231.60 463.20 0272943966
3 3 9 62 4 248 310.80 621.60 0272924686

0 3 0 76 4 304 362.00 724.00 0272909571
0 3 0 76 4 304 368.00 736.00 0272302740

Page 89 of 248
MBER 2017

ABSENSI
0 3 0 62 4 248 299.40 598.80 0272924660
0 3 0 62 4 248 299.00 598.00 0272300992
0 3 0 62 4 248 299.80 599.60 0272304491
0 3 0 64 4 256 308.40 616.80 0272485551
0 3 0 64 4 256 308.80 617.60 0272893993
0 3 0 54 4 216 261.80 523.60 0272304980
0 3 0 60 4 240 290.40 580.80 0272943982
0 3 0 58 4 232 286.20 572.40 0272509077
0 3 0 48 4 192 235.20 470.40 0272509701
0 3 0 48 4 192 234.80 469.60 0272509310
0 3 0 44 4 176 217.20 434.40 0272649197
0 3 0 44 4 176 216.80 433.60 0272612501
0 3 0 54 4 216 268.60 537.20 0272702713
0 3 0 44 4 176 216.80 433.60 0272702853
0 3 0 44 4 176 216.80 433.60 0272702675
0 3 0 44 4 176 216.40 432.80 0272794553
0 3 0 44 4 176 210.40 420.80 0272832421

0 3 0 42 4 168 199.40 398.80 0272982791
KSM Bedah 0 3 0 114 4 456 567.00 567.00 0272925861

KSM Gigi 0 3 0 112 4 448 532.40 532.40 0272304394
nggung jawab ICU 3 3 9 104 4 416 537.00 1,074.00 0272118175
Ka. IRNA 5 3 15 102 4 408 495.20 990.40 0272926662
Ka. IRJA 5 3 15 104 4 416 510.60 1,021.20 0273012966
Ka. KSM Mata 3 3 9 110 4 440 558.80 558.80 0272976899
Ka. KSM Saraf 3 3 9 110 4 440 558.40 558.40 0272118876
Ka. KSM Paru 3 3 9 110 4 440 557.60 557.60 0272118752
Ka. KSM PA 0 3 0 102 4 408 513.40 513.40 0322303041
Ka. KSM 0 3 0 106 4 424 523.40 523.40 0272118345
Ka. KSM Bedah 0 3 0 106 4 424 531.00 531.00 0276044672
Ka. KSM Radiologi 3 3 9 100 4 400 506.60 506.60 0272794065

Page 90 of 248
MBER 2017

ABSENSI
KSM gigi 0 3 0 100 4 400 477.60 477.60 0272118591
Ka. KSM Kulkel 0 3 0 106 4 424 520.20 520.20 0272899347
Ka. KSM Gigi 3 3 9 96 4 384 470.60 470.60 0272978760
0 3 0 96 4 384 458.80 917.60 0272911231
KSM Obsgyn 0 3 0 94 4 376 477.80 477.80 0272978221
Ka. Inst. Radiologi 5 3 15 102 4 408 521.60 521.60 0272596247
KSM Umum 0 3 0 88 4 352 453.00 453.00 0382069700
0 3 0 92 4 368 468.80 468.80 0322305834
Ka. KSM Jantung 0 3 0 92 4 368 467.60 467.60 0272958572
D/Ka. KSM Umum 5 3 15 82 4 328 441.60 441.60 0272928282
KSM THT 0 3 0 70 4 280 371.00 371.00 0272897247
KSM Umum 0 3 0 68 4 272 359.60 359.60 0272507333
KSM Dalam 0 3 0 98 4 392 494.20 494.20 0322279043
SMF Umum 0 3 0 64 4 256 340.40 340.40 0017082965
KSM Anak 3 3 9 66 4 264 360.40 360.40 0277026791
KSM Saraf 0 3 0 66 4 264 350.60 350.60 0272502781
KSM Paru 0 3 0 62 4 248 333.80 333.80 0272591016
KSM Dalam 0 3 0 64 4 256 340.80 340.80 0322670435
KSM Umum 0 3 0 74 4 296 385.40 385.40 0272649642
KSM Anestesi 0 3 0 56 4 224 304.80 304.80 0272794031
KSM Obsgyn 0 3 0 52 4 208 287.20 287.20 0272794103
Ka. KSM THT 3 3 9 100 4 400 512.60 512.60 0282217023
Ka. KSM Anak 0 3 0 78 4 312 404.20 404.20 0322771720
KSM KK 0 3 0 60 4 240 310.40 310.40 0272794235
KSM Saraf 0 3 0 60 4 240 322.40 322.40 0272794375
KSM Anestesi 0 3 0 58 4 232 313.00 313.00 0272794383
KSM Umum 0 3 0 56 4 224 302.40 302.40 0017083023
KSM Jantung 0 3 0 60 4 240 322.40 322.40 0272794812
Ka.Inst PK 5 3 15 96 4 384 494.60 494.60 0277000067
KSM Mata 0 3 0 62 4 248 332.20 332.20 0322788550
KSM Bedah 0 3 0 56 4 224 305.60 305.60 0272980471
KSM Anak 0 3 0 74 4 296 386.60 386.60 0322815336
KSM Obsgyn 0 3 0 60 4 240 323.20 323.20 0272960526
KSM Dalam 0 3 0 56 4 224 305.60 305.60 0017501259

Page 91 of 248
MBER 2017

ABSENSI
KSM Gigi 0 3 0 56 4 224 281.20 281.20 0277000130
KSM Bedah 0 3 0 54 4 216 295.00 295.00 0277000385
KSM Umum 0 3 0 54 4 216 293.00 293.00 0277000407
KSM Gigi 0 3 0 68 4 272 335.20 335.20 0272536759
KSM Anak 0 3 0 66 4 264 350.20 350.20 0272831173
KSM Paru 0 3 0 54 4 216 295.00 295.00 0802036205
KSM Bedah 0 3 0 54 4 216 295.00 295.00 0277006553
KSM Jantung 0 3 0 54 4 216 295.00 295.00 0277019680
KSM Mata 0 3 0 54 4 216 295.00 295.00 0277006651
KSM Mata 0 3 0 54 4 216 295.00 295.00 0172094112
KSM Umum 0 3 0 54 4 216 293.00 293.00 0277014271
Inst. Rehab Medik 5 3 15 54 4 216 292.00 292.00 0272924708
KSM Umum 0 3 0 54 4 216 293.00 293.00 0277006812
KSM Umum 0 3 0 54 4 216 293.00 293.00 0277017261
KSM Umum 0 3 0 54 4 216 293.00 293.00 0277019655
KSM Umum 0 3 0 54 4 216 293.00 293.00 0162638483
KSM Umum 0 3 0 54 4 216 293.00 293.00 0277019663
Ka. IKF 0 3 0 54 4 216 295.00 295.00 0277020025
KSM Dalam 0 3 0 78 4 312 404.20 404.20 0272535841
Ka Unit BDRS 5 3 15 70 4 280 377.60 377.60 0272455716
KSM Dalam 0 3 0 54 4 216 295.00 295.00 0272840601
Spes. Jiwa 0 3 0 78 4 312 379.00 379.00 0272979936
KSM Anestesi 0 3 0 54 4 216 295.00 295.00 0277019779
KSM Obsgyn 0 3 0 54 4 216 295.00 295.00 0277019841
KSM Umum 0 3 0 54 4 216 293.00 293.00 0322217285
KSM Umum 0 3 0 70 4 280 366.20 366.20 0277019809
KSM Umum 0 3 0 52 4 208 284.00 284.00 0273437011
KSM Umum 0 3 0 52 4 208 284.00 284.00 0277026741
KSM Bedah 0 3 0 52 4 208 286.00 286.00 0277026708
KSM Dalam 0 3 0 52 4 208 286.00 286.00 0323665460
KSM Umum 0 3 0 52 4 208 142.00 142.00 0533013201
KSM Umum 0 3 0 52 4 208 142.00 142.00 0277037882
KSM Umum 0 3 0 52 4 208 142.00 142.00 0706066071
0272906793

Page 92 of 248
MBER 2017

ABSENSI
0272649596
275,536.40 338,691.00 162,812.00

Page 93 of 248
SKOR TOTAL KEBERSAMAAN
KOMPER BY.UNIT
BY.KOM 25%
-
-
- CUTI HAJI 18 AGUST - 26 SEPT 2017
-
-
-
-
-
-
2,466,127.11
2,138,293.28
1,832,012.55
1,953,390.47
1,668,662.82
1,866,043.74
1,664,125.33
2,008,974.75
1,557,494.26
1,535,941.17
1,586,987.96
1,584,719.21
1,638,034.75
1,351,038.36
1,482,625.63
1,586,987.96
1,484,894.38
1,028,876.40
1,433,847.59
1,142,313.71
1,142,313.71
8,063.91 CUTI 3 JUNI - 2 SEPT 2017

Page 94 of 248
KOMPER BY.UNIT
BY.KOM 25%
1,635,766.00
1,378,263.31
-
-
-
-
-
2,259,671.20
2,367,436.65
1,795,712.61
1,982,884.17
1,951,121.72
1,886,462.46
1,614,212.91
1,733,322.09
1,812,728.20
1,846,759.40
1,795,712.61
1,897,806.19
1,661,856.58
1,659,587.84
1,693,619.03
1,659,587.84
1,586,987.96
1,635,766.00
1,584,719.21
1,454,266.31
1,695,887.78
1,318,141.54
1,589,256.71
1,465,610.04
- CUTI 21 JUNI - 20 SEP 2017
1,465,610.04
1,518,925.57

Page 95 of 248
KOMPER BY.UNIT
BY.KOM 25%
-
-
- PENSIUN PER 1 AGUST 2017
-
-
2,074,768.39
1,684,544.05
1,948,852.98
1,763,950.16
1,849,028.14
1,978,346.68
1,763,950.16
1,712,903.37
1,693,619.03
1,610,809.79
1,480,356.89
- PINDAH PER 1 JUNI 2017
1,537,427.43 CUTI 1 AGUST - 1 NOP 2017
1,546,150.53
1,529,134.93
1,817,265.70
1,817,265.70
1,868,312.49
2,016,915.36
1,369,188.33
1,369,188.33
1,351,038.36
1,331,754.01
1,329,485.27
1,318,141.54
1,337,425.88
1,152,788.58 CUTI 21 AGUST - 21 NOP 2017
1,284,110.34
1,142,313.71

Page 96 of 248
KOMPER BY.UNIT
BY.KOM 25%
1,267,094.75 CUTI 15 PEB-14 MEI 2017
2,493,352.06
2,206,355.67
1,897,806.19
2,033,930.96
1,846,759.40
1,744,665.82
1,846,759.40
1,591,525.45
1,593,794.20
1,227,391.69
1,429,310.10
1,352,172.73 CUTI 30 NOP 2016 - 26 PEB 2017
1,227,391.69
1,295,454.07
2,046,409.06
1,800,250.10
1,518,925.57
1,516,656.83 CUTI 16 APR - 15 JULI 2017
1,227,391.69
1,301,125.94
1,176,344.90
1,174,076.15
1,174,076.15
1,088,998.17 PEG BARU PER 1 NOP 2016
- PEG BARU PER 21 AGUST 2017 (50%)
-
-
-
- KASUBID PER 4 JAN 2017
-
2,104,262.09
1,814,996.95
1,586,987.96

Page 97 of 248
KOMPER BY.UNIT
BY.KOM 25%
1,433,847.59
1,431,578.85
1,429,310.10 CUTI 1 MART - 31 MEI 2017
-
-
-
-
-
1,661,856.58
1,610,809.79
1,638,034.75
-
-
-
-
-
1,863,774.99
1,642,572.24
1,391,875.79 Pindah dr. R.WK per 1 Juni 2017
2,370,839.77
2,126,949.55
1,429,310.10
1,213,779.21 PEG BARU PER 1 PEB 2017
-
466.00 1,321,544.66
413.00 1,171,240.22
360.80 1,023,204.53 CUTI 4 MART - 3 JUNI 2017
342.40 971,023.37
80.75 916,006.27
269.20 763,433.09
259.40 735,640.95

Page 98 of 248
KOMPER BY.UNIT
BY.KOM 25%
268.80 762,298.72
291.60 826,957.99
250.80 711,251.93
259.80 736,775.32
270.40 766,836.21
241.00 683,459.79
250.00 708,983.18
232.00 657,936.39 PEG BARU PER 1 NOP 2016
232.00 330,824.18 PEG BARU PER 22 MEI 2017
232.00 330,824.18 PEG BARU PER 22 MEI 2017
4,719.95 -
-
451.60 1,280,707.22
452.40 1,282,975.97
361.60 1,025,473.28
343.60 974,426.49
82.90 940,395.30
59.50 674,951.99
344.00 975,560.86 CUTI 27 OKT 2015 - 26 JAN 2016
342.80 972,157.74
83.00 941,529.67
269.20 763,433.09
270.00 765,701.84
270.00 765,701.84
261.00 740,178.44 CUTI 22 AGUST - 21 NOP 2015
269.60 764,567.47 CUTI 24 JULI - 23 OKT 2016
297.80 844,540.77 CUTI 4 SEPT - 3 DES 2015
288.40 817,883.00 dipinjam IGD per 1 Jan - 30 Juni 2015
260.60 739,044.07 TIDAK MASUK KERJA 4 - 22 PEB 2017
260.60 739,044.07 CUTI 7 OKT 2016 - 6 JAN 2017
- 708,367.15 CUTI 31 JULI - 31 OKT 2017
251.60 713,520.68
260.20 737,909.70 CUTI 18 JUNI - 17 SEPT 2015 No.12
251.20 712,386.30 CUTI 2 DES 2016 - 1 MART 2017

Page 99 of 248
KOMPER BY.UNIT
BY.KOM 25%
251.20 712,386.30 Dipinjam IGD per 1 Juli - 31 Des 2015
242.20 686,862.91
241.00 683,459.79 CUTI 20 SEPT - 19 DES 2017
241.00 683,459.79
241.80 685,728.54 Pindah dri R.B per 1 Jan - 31 Juni 2016
241.80 685,728.54 PEG BARU PER 13 APRIL 2016
7,190.60 -
-
507.00 1,437,817.90
453.60 1,286,379.09
424.20 1,203,002.67
365.40 1,036,249.82
364.20 1,032,846.70
355.20 1,007,323.31
356.80 1,011,860.80
347.80 986,337.41 CUTI 3 OKT 2016 - 2 JAN 2017
355.20 1,007,323.31
348.60 988,606.15 CUTI 3 OKT 2016 - 2 JAN 2017
346.60 982,934.29
364.60 1,033,981.08
80.75 916,006.27
272.20 771,940.89
47.85 542,797.53
271.80 770,806.52 Pindah dr R.A per 1 Juni 2017
291.80 827,525.17
262.40 744,148.75
262.80 745,283.12 CUTI 11 NOP 2015 - 13 PEB 2016
- - CUTI 1 JULI - 1 OKT 2017
262.40 744,148.75
244.00 347,935.77 PEG BARU PER 22 MEI 2017
244.00 347,935.77 PEG BARU PER 22 MEI 2017
275.00 392,140.73 PEG BARU PER 22 MEI 2017
244.00 347,935.77 PEG BARU PER 22 MEI 2017
7,348.20 -

Page 100 of 248
KOMPER BY.UNIT
BY.KOM 25%
-
512.00 1,451,997.56
309.60 878,004.78
323.20 916,573.46 CUTI HAJI 1 SEP- 31 OKT 2015
320.00 907,498.48
83.00 941,529.67
78.50 890,482.88
288.40 817,883.00 CUTI 4 SEPT - 3 DES 2015
51.00 578,530.28
269.20 763,433.09
269.20 763,433.09
259.80 736,775.32 CUTI 12 NOP 2016 - 11 PEB 2017
259.80 736,775.32
47.85 542,797.53
259.80 736,775.32
241.00 683,459.79
241.00 683,459.79
270.80 767,970.58
241.00 683,459.79
241.00 683,459.79
241.00 683,459.79
232.00 330,824.18 PEG BARU PER 22 MEI 2017
232.00 330,824.18 PEG BARU PER 22 MEI 2017
5,271.15 -
-
529.60 1,501,909.98 UMROH 22 PEB - 7 MART 2017
435.20 1,234,197.93
343.60 974,426.49 CUTI 1 PEB - 30 APR 2016
78.50 890,482.88
82.90 940,395.30
269.20 763,433.09
269.20 763,433.09
269.20 763,433.09
47.85 542,797.53

Page 101 of 248
KOMPER BY.UNIT
BY.KOM 25%
268.80 762,298.72
268.80 762,298.72
268.80 762,298.72 pindah dr R.G per 1 Juni 2017
268.80 762,298.72 pindah dr R.H per 1 Juni 2017
281.40 798,031.47
241.80 685,728.54
241.00 683,459.79
241.40 684,594.16
241.00 683,459.79
241.00 683,459.79
263.00 745,850.31 PEG BARU PER 1 NOP 2016
263.00 745,850.31 PEG BARU PER 1 NOP 2016
232.00 657,936.39 PEG BARU PER 1 NOP 2016
232.00 657,936.39 PEG BARU PER 1 NOP 2016
232.00 657,936.39 PEG BARU PER 1 NOP 2016
232.00 657,936.39 PEG BARU PER 1 NOP 2016
232.00 657,936.39 PEG BARU PER 1 NOP 2016
263.00 375,029.13 PEG BARU PER 22 MEI 2017
6,837.05 -
-
430.20 1,220,018.26 pindah dr R.G per 1 Juni 2017
334.20 947,768.72 pindah dr R.WK per 1 Juni 2017
333.40 945,499.97 pindah dr R.D per 1 Juni 2017
333.40 945,499.97 pindah dr R.C per 1 Juni 2017
259.40 735,640.95 pindah dr R.WK per 1 Juni 2017
241.00 683,459.79 pindah dr P.Dalam per 1 Juni 2017
241.00 683,459.79 pindah dr R.A per 1 Juni 2017
281.40 798,031.47 CUTI 10 APR - 9 JULI 2016
263.00 375,029.13 PEG BARU PER 22 MEI 2017
232.00 330,824.18 PEG BARU PER 22 MEI 2017
232.00 330,824.18 PEG BARU PER 22 MEI 2017

Page 102 of 248
KOMPER BY.UNIT
BY.KOM 25%
232.00 330,824.18 PEG BARU PER 22 MEI 2017
232.00 330,824.18 PEG BARU PER 22 MEI 2017
4,320.95
-
458.00 1,298,857.19 UMROH 21 DES 2016 - 5 JAN 2017
413.80 1,173,508.97
342.80 972,157.74
288.40 817,883.00 CUTI 23 MEI - 22 AGUST 2016
288.00 816,748.63 Pindah dr R.H
80.75 916,006.27
73.50 833,764.22
260.20 737,909.70
260.20 737,909.70
269.20 763,433.09 Pindah dr R.D
50.60 573,992.79
241.40 684,594.16 UMROH 18 - 31 DES 2016
250.40 710,117.56
250.40 710,117.56
268.80 762,298.72 Pindah dr R.WK
281.40 798,031.47
241.00 683,459.79
241.00 683,459.79 CUTI 12 MART - 11 JUNI 2017
679,603.83 CUTI 16 JULI - 15 OKT 2017
241.00 683,459.79
241.00 683,459.79
7,946.80
360.80 1,023,204.53
268.80 762,298.72
269.20 763,433.09 CUTI 13 AGUST - 12 NOP 2016
269.20 763,433.09
269.20 763,433.09 pindah dr R.G per 1 Juni 2017
263.00 745,850.31 PEG BARU PER 1 NOP 2016
263.00 745,850.31 PEG BARU PER 1 NOP 2016

Page 103 of 248
KOMPER BY.UNIT
BY.KOM 25%
232.00 657,936.39 PEG BARU PER 1 NOP 2016
263.00 375,029.13 PEG BARU PER 22 MEI 2017
263.00 375,029.13 PEG BARU PER 22 MEI 2017
2,721.20 -
478.40 1,356,710.22 Pindah dr R.F per 1 Mei 2015

333.80 946,634.35 CUTI 25 MEI - 24 AGUST 2015
76.15 863,825.11 CUTI 9 PEB - 8 MEI 2015
268.80 762,298.72 CUTI 24 JAN - 23 APR 2017
241.80 685,728.54 CUTI 22 APR - 21 JUNI 2016
269.20 763,433.09
268.80 762,298.72
241.00 683,459.79
263.00 745,850.31 PEG BARU PER 1 NOP 2016
232.00 657,936.39 PEG BARU PER 1 NOP 2016
- 741,642.36 CUTI 5 SEPT - 4 DES 2017
- - CUTI 7 JULI - 6 OKT 2017
232.00 330,824.18 PEG BARU PER 22 MEI 2017
-
457.20 1,296,588.45
333.40 945,499.97 CUTI 15 JAN - 14 APR 2017
80.65 914,871.90
288.40 817,883.00
334.20 947,768.72 Pindah dr bid kep per 1 peb '17
259.40 735,640.95
269.20 763,433.09
47.85 542,797.53
259.80 736,775.32
259.80 736,775.32
250.40 710,117.56 CUTI 5 MEI - 4 AGUST 2015
241.40 684,594.16
241.00 683,459.79 CUTI 10 OKT 2016 - 9 JAN 2017
263.00 745,850.31 PEG BARU PER 1 NOP 2016

Page 104 of 248
KOMPER BY.UNIT
BY.KOM 25%
232.00 657,936.39 PEG BARU PER 1 NOP 2016
263.00 375,029.13 PEG BARU PER 22 MEI 2017
232.00 330,824.18 PEG BARU PER 22 MEI 2017
232.00 330,824.18 PEG BARU PER 22 MEI 2017
4,544.70 -
-
468.40 1,328,350.89
439.20 1,245,541.66
80.65 914,871.90
294.00 833,764.22 CUTI 14 JAN - 13 APR 2016
321.40 942,664.04
332.40 911,468.78 Pindah dr ICU per sept 2017
47.85 542,797.53
296.40 840,570.46
275.20 780,448.69
274.80 779,314.32 CUTI 1 PEB - 30 APR 2017
274.80 779,314.32
247.40 701,609.76
247.00 700,475.39
238.00 674,951.99 PEG BARU PER 1 NOP 2016
238.00 674,951.99 PEG BARU PER 1 NOP 2016
238.00 339,379.97 PEG BARU PER 22 MEI 2017
238.00 674,951.99 PEG BARU PER 1 NOP 2016
4,551.50 -
-
1,263,893.93 CUTI HAJI 14 AGUST - 18 OKT 2017
307.20 871,198.54
339.00 961,381.20
353.00 1,001,084.26 DIKLAT 17 OKT 2016 - 16 JAN 2017
76.15 863,825.11
268.80 762,298.72
259.80 736,775.32
259.40 735,640.95
259.80 736,775.32 CUTI 15 JULI - 14 OKT 2015

Page 105 of 248
KOMPER BY.UNIT
BY.KOM 25%
680,731.81 CUTI 14 AGUST - 14 NOP 2017
241.40 684,594.16
241.00 683,459.79
241.00 683,459.79
263.00 745,850.31 PEG BARU PER 1 NOP 2016
232.00 657,936.39 PEG BARU PER 1 NOP 2016
232.00 330,824.18 PEG BARU PER 22 MEI 2017
241.00 683,459.79 Pinjaman dr R.Edelweis 1 agus - 30 okt 2017
263.00 745,850.31 Pinjaman dr R.Edelweis 1 agus - 30 okt 2017
50.60 573,992.79 CUTI 14 APR - 14 MEI 2017
4,128.15
-
521.60 4.67 1,479,222.52 UMROH 20 MART - 1 APRIL 2017
457.20 4.21 1,296,588.45 CUTI HAJI 1 SEP- 31 OKT 2015
471.40 4.44 1,336,858.69
453.40 3.97 1,285,811.90
423.40 4.21 1,200,733.92
451.20 4.21 1,279,572.85 CUTI HAJI 1 SEP- 31 OKT 2015
409.20 4.21 1,160,463.68 CUTI HAJI 1 SEP- 31 OKT 2015
426.80 4.21 1,210,376.09
413.60 4.21 1,172,941.78
393.20 3.74 1,115,088.75 Pinjam IBS per 27 Okt 2015
372.00 3.74 1,054,966.98
346.60 3.51 982,934.29
354.00 3.51 1,003,920.19
348.20 3.51 987,471.78
356.40 3.97 1,010,726.43
83.00 2.34 941,529.67
364.60 3.74 1,033,981.08
82.90 2.34 940,395.30
308.60 3.27 875,168.84
326.60 3.27 926,215.63
357.20 3.27 1,012,995.17 DIKLAT 27 OKT 2015 - 27 JAN 2016
57.85 1.64 656,234.84

Page 106 of 248
KOMPER BY.UNIT
BY.KOM 25%
57.85 1.64 656,234.84
57.85 1.64 656,234.84
50.60 1.64 573,992.79
280.40 3.27 795,195.54
305.60 3.27 866,661.04 DIKLAT 1 PEB - 30 APRIL 2016
253.40 2.80 718,625.36 Pindah dr ROL per 1 Juni 2017
253.40 2.80 718,625.36 Pindah dr IGD per 1 Juni 2017
244.40 2.80 693,101.96 Pindah dr ROL per 1 Juni 2017
100.00
-
527.20 8.14 1,495,103.74
462.20 7.90 1,310,768.11
- 6.70 1,255,434.13 CUTI HAJI 12 AGUST - 4 OKT 2017
416.20 6.70 1,180,315.20 CUTI UMROH 9 - 22 PEB 2016
423.80 7.42 1,201,868.29
374.00 7.18 1,060,638.84 CUTI 1 NOP 2015 - 31 JAN 2016
340.40 7.42 965,351.50
402.20 7.18 1,140,612.15
336.80 6.46 955,142.15 DIKLAT 11 JAN 2016 - 10 JAN 2017
347.40 7.42 985,203.03 UMROH 13 - 25 MART 2017
345.00 6.46 978,396.79
347.40 7.18 985,203.03 CUTI 4 MEI - 4 AGUST 2015
338.00 6.94 958,545.26
347.40 6.94 985,203.03
100.00
2,233,580.62
1,859,237.50
1,157,060.56
1,157,060.56
1,157,060.56
-
427.60 1,212,644.84

Page 107 of 248
KOMPER BY.UNIT
BY.KOM 25%
424.60 1,204,137.04
390.40 1,107,148.14
404.00 1,145,716.83
365.40 1,036,249.82
383.80 1,088,430.98 CUTI TKHI 20 AGUST - 10 OKT 2016
383.40 1,087,296.61
346.60 982,934.29
355.60 1,008,457.68
- 971,748.88 CUTI 2 AGUS - 1 NOP 2017
300.80 853,048.57
300.00 850,779.82 CUTI 27 DES 2015 - 26 PEB 2016
83.10 942,664.04
281.60 798,598.66 CUTI 7 OKT 2015 - 6 JAN 2016
281.20 797,464.29 CUTI 17 NOP 2015 - 17 PEB 2016
272.20 771,940.89
271.80 770,806.52 CUTI 6 PEB - 6 MEI 2017
404.60 1,147,418.39
281.20 797,464.29
254.60 722,028.47
275.00 392,140.73 PEG BARU PER 22 MEI 2017
275.00 392,140.73 PEG BARU PER 22 MEI 2017
244.00 347,935.77 PEG BARU PER 22 MEI 2017
244.00 347,935.77 Pindah ICU Per September 2017
7,250.50 -
-
435.80 1,235,899.49
421.00 1,193,927.68
391.60 1,110,551.26
419.40 1,189,390.19
423.40 1,200,733.92 Pindah per juli 2015
363.80 1,031,712.33
356.00 1,009,592.05
345.80 980,665.54
345.00 978,396.79

Page 108 of 248
KOMPER BY.UNIT
BY.KOM 25%
345.80 980,665.54
354.80 1,006,188.93
345.00 978,396.79
80.75 916,006.27
57.85 656,234.84
271.40 769,672.14
262.40 744,148.75
76.15 863,825.11
57.85 656,234.84 CUTI 30 MART - 30 MEI 2016
301.20 854,182.94 CUTI 18 MART - 17 JUNI 2015
271.40 769,672.14
271.80 770,806.52
291.80 827,525.17
262.40 744,148.75
262.80 745,283.12
51.10 579,664.65
70.60 800,867.40
253.80 719,759.73 CUTI 11 PEB -11 MEI 2017
253.80 719,759.73 Pindah dri R.B per 1 Jan - 31 Juni 2016
281.20 797,464.29 Pindah dr R.WK
271.80 770,806.52 CUTI 18 JAN - 17 APR 2016
271.80 770,806.52
262.40 744,148.75
253.40 718,625.36
282.40 800,867.40
253.00 717,490.98
253.00 717,490.98
253.00 4,047.95 CUTI 21 APR - 20 JULI 2017
282.40 800,867.40 Pindah dr R.B per 1 Agust 2016
253.00 717,490.98

Page 109 of 248
KOMPER BY.UNIT
BY.KOM 25%
271.80 770,806.52
244.00 347,935.77 PEG BARU PER 22 MEI 2017
12,158.70 -
-
- 1,147,148.71 CUTI HAJI 24 JULI - 23 SEPT 2017
363.20 1,030,010.77 CUTI 25 SEPT - 24 DES 2015
378.80 1,074,251.32
353.00 1,001,084.26
395.40 1,121,327.80
352.20 998,815.51
344.40 976,695.23
362.20 1,027,174.84
353.80 1,003,353.00
354.60 1,005,621.75
325.60 923,379.70
261.40 741,312.82
55.60 630,711.44
252.80 716,923.80
4,153.00 -
-
471.60 1,337,425.88
411.00 1,165,568.35 UMROH 19 - 31 DES 2016
327.40 928,484.38 Pindah dari P.VIP per 6-9-2017
55.60 630,711.44
1,265.60 -
-
438.40 1,243,272.91
267.40 758,328.41 Pindah dr P.Saraf per 1 Juni 2017
705.80
339.40 962,515.57
339.40 -
470.40 1,334,022.76

Page 110 of 248
KOMPER BY.UNIT
BY.KOM 25%
434.20 1,231,361.99
339.60 954,007.77
336.40 963,082.76 Pindah dari Endos per 6-9-2017
1,580.60 -
-
425.20 1,205,838.60
682.40 -
-
472.60 1,340,261.81
429.40 1,217,749.52 Pindah per Juli 2015
339.40 962,515.57
330.00 935,857.80
1,571.40 -
-
435.00 1,233,630.74 Pindah dr Poli THT per 1 Mei 2015
402.00 1,140,044.96
366.40 1,039,085.75 Pindah dr. R.G
285.00 808,240.83 UMROH 29 DES 2016 - 10 JAN 2017
311.60 883,676.64
341.80 969,321.81 DIKLAT 17 OKT 2016 - 16 JAN 2017
338.60 960,246.82
2,480.40 -
-
460.80 1,306,797.80
392.60 1,113,387.19
323.00 916,006.27 Pindah dr R.NICU per 1 Juni 2017
321.80 912,603.15
1,498.20 -
-
447.80 1,269,930.68
366.00 1,037,951.38
322.20 913,737.53
331.60 940,395.30 Pindah dr ROL per 1 Juni 2017

Page 111 of 248
KOMPER BY.UNIT
BY.KOM 25%
1,467.60 -
-
430.60 1,221,152.64
329.60 934,723.43
275.60 781,583.06
256.40 727,133.15
- 931,705.84 CUTI 18 AGUST - 18 NOP 2017
- - CUTI DILUAR TANGGUNGAN NEGARA PER 1 JAN 2015 (2
220.00 623,905.20 Pindah dr R.E per 21 Agust 2017
1,512.20 -
-
448.60 1,272,199.43
428.60 1,215,480.77
877.20 -
-
458.40 1,299,991.57
395.00 1,120,193.43
853.40 -
-
434.20 1,231,361.99
330.80 938,126.55
765.00 -
-
411.40 1,166,702.73
325.20 922,245.33 CUTI 10 MEI - 9 AGUST 2016
51.10 579,664.65 CUTI 10 PEB 2017-10 MEI 2017
229.00 649,428.60 PEG BARU PER 7 DES 2015
1,016.70 -
-
516.80 1,465,610.04
402.40 1,141,179.33
78.50 890,482.88
997.70 -
-

Page 112 of 248
KOMPER BY.UNIT
BY.KOM 25%
457.60 1,297,722.82 UMROH 13 - 24 DES 2016
292.80 830,361.11
750.40 -
-
- 954,829.29 CUTI 12 AGUS - 11 NOP 2017
229.00 649,428.60 PEG BARU PER 7 MARET 2016
249.00 706,147.25 PEG BARU PER 16 PEB 2017
478.00
-
15.00 1,248,944.78 CUTI HAJI 20 AGUST - 10 OKT 2016
10.00 943,798.41
11.00 969,321.81
14.00 728,267.53
- KELUAR PER 1 JUNI 2017
12.50 676,086.36
7.00 605,188.05 CUTI 1 JAN - 1 APRIL 2015
7.00 724,297.22 Pinjam dr IGD per 29 Des 2014 - 2 Apr 2015
8.50 650,562.97 BARU PER 2 JAN 2015
7.50 326,546.28 PEG BARU PER 22 MEI 2017
7.50 326,546.28 PEG BARU PER 22 MEI 2017
100.00 -
-
0.50 781,583.06 CUTI 5 PEB- 6 MEI 2017
0.50 786,120.55
313,712.58 PEG BARU PER 22 MEI 2017
1.00 -
-
434.60 1,232,496.37
-
-
361.00 1,023,771.72
78.65 892,184.44
274.40 778,179.94
274.40 778,179.94

Page 113 of 248
KOMPER BY.UNIT
BY.KOM 25%
58.70 665,877.01
56.35 639,219.24
1,103.50 -
-
12.50 1,233,438.66 CUTI HAJI 11 AGUST - 26 SEPT 2017
7.50 959,341.18 CUTI HAJI 15 AGUST - 23 SEPT 2017
11.00 1,058,370.10
9.60 994,845.20
7.50 1,068,012.27
7.50 910,334.41
8.90 884,811.01
7.50 884,811.01
5.50 964,784.32
5.50 729,401.90
5.00 859,287.62
5.50 701,609.76
- KELUAR PER MEI 2017
100.00 -
-
10.00 1,306,230.62 UMROH 23 APR - 7 MEI 2015
7.00 1,352,172.73
8.00 1,124,163.74
7.00 1,022,070.16
7.00 995,412.39
7.00 999,949.88
6.00 971,023.37
6.00 943,231.23
6.00 972,157.74
6.00 969,889.00
6.00 944,365.60
6.00 866,661.04
7.00 1,008,457.68
5.50 757,194.04

Page 114 of 248
KOMPER BY.UNIT
BY.KOM 25%
5.00 841,137.65 PINDAH PER 1 AGUST 2017
6.00 761,164.35 CUTI 21 JAN - 20 APR 2015
6.00 761,164.35 CUTI 8 DES 2015 - 7 PEB 2016
6.00 735,640.95
6.00 736,775.32
5.00 684,594.16
5.00 684,594.16 CUTI 26 NOP 2016 - 25 PEB 2017
5.00 684,594.16
5.00 657,936.39 PEG BARU PER 1 NOP 2016
5.00 657,936.39 PEG BARU PER 1 NOP 2016
6.00 1,162,165.24
5.00 739,044.07 CUTI 18 AGUST - 17 NOP 2016
5.00 713,520.68
5.00 685,728.54
330,824.18 PEG BARU PER 22 MEI 2017
184.50 -
-
2,732,704.78
2,638,551.82
2,416,214.69
2,534,189.49
2,238,118.12
2,293,702.40
1,838,818.79 UMROH 27 MART - 6 APRIL 2017
1,871,715.61
1,951,121.72
1,746,934.57
1,849,028.14
1,864,909.37

Page 115 of 248
KOMPER BY.UNIT
BY.KOM 25%
1,647,109.73
1,480,356.89 CUTI 1 AGUST - 31 OKT 2015
1,482,625.63
1,469,013.16
1,471,281.90
1,366,919.58
1,480,356.89
1,378,263.31
1,284,761.44 KELUAR PER 1 AGUST 2017
1,292,050.95
1,334,022.76
1,331,754.01
1,331,754.01
1,280,707.22
1,278,438.48
1,280,707.22
1,280,707.22
1,354,441.47
1,222,722.91 CUTI 12 AGUS - 9 NOP 2017
1,229,660.43 CUTI 14 APR - 13 JULI 2017
1,178,613.65 PEG BARU PER 1 JAN 2015
1,455,085.39 CUTI 1 SEPT - 29 NOP 2017
1,298,857.19 PEG BARU PER 13 APRIL 2016
1,329,485.27 Pindah dr Gizi per 1/6/16
627,425.16 PEG BARU PER 22 MEI 2017
627,425.16 PEG BARU PER 22 MEI 2017
627,425.16 PEG BARU PER 22 MEI 2017
-
-
1,967,002.95
1,817,265.70
1,678,872.18 UMROH 27 MART - 6 APRIL 2017
1,761,681.42
1,347,635.24

Page 116 of 248
KOMPER BY.UNIT
BY.KOM 25%
1,691,350.28
1,695,887.78
1,749,203.31
1,437,250.71
1,261,422.88
1,386,203.92
1,390,741.41
1,210,376.09
1,210,376.09
1,335,157.13 CUTI 25 SEPT - 25 DES 2017
1,088,998.17
1,088,998.17 PEG BARU PER 1 NOP 2016
1,088,998.17 PEG BARU PER 1 NOP 2016
1,088,998.17 PEG BARU PER 1 NOP 2016
610,313.57 PEG BARU PER 22 MEI 2017
610,313.57 PEG BARU PER 22 MEI 2017
-
2,604,520.62
2,704,345.46
2,217,699.40 CUTI 1 DES 2015 - 1 MART 2016
1,964,734.20
2,067,962.15
1,761,681.42
1,812,728.20
1,699,290.90
1,546,150.53
1,534,806.80
1,279,572.85
1,446,325.70
1,397,547.65
1,397,547.65 CUTI 16 JAN - 15 APR 2017
1,914,821.78
1,590,391.08 Pindah dr Ambulance per 1 Jan 2015

Page 117 of 248
KOMPER BY.UNIT
BY.KOM 25%
1,763,950.16 Pindah Per Peb 2015
1,499,641.23
661,648.35 PEG BARU PER 22 MEI 2017
661,648.35 PEG BARU PER 22 MEI 2017
661,648.35 PEG BARU PER 22 MEI 2017
-
-
1,121,894.99
1,230,794.81
1,138,910.59
971,023.37
949,470.28
1,095,804.41
1,025,473.28
1,043,623.25
979,531.17
923,379.70
839,436.09
873,467.28
5,017.54 CUTI 1 MEI - 31 JULI 2017
821,286.12
849,078.26
846,809.52 CUTI 2 JAN - 30 JAN 2016
864,959.48
822,420.49
821,286.12 CUTI 20 APR - 13 JULI 2015
907,498.48
829,793.92
788,389.30
787,254.93
788,389.30
849,645.45
807,106.46
807,106.46

Page 118 of 248
KOMPER BY.UNIT
BY.KOM 25%
807,106.46 CUTI 17 PEB - 16 MEI 2015
740,178.44
771,373.70 UMROH 10 - 22 DES 2016
815,047.07 CUTI 1 JUNI 2016 - 1 SEP 2016
816,181.44 CUTI 1 PEB - 30 APR 2017
701,609.76
701,609.76
664,742.63
681,758.23
664,742.63
701,609.76
613,695.84
630,711.44
613,695.84
613,695.84
613,695.84
786,687.74 CUTI 16 JAN - 15 APR 2017
737,342.51 PEG BARU PER 13 APRIL 2016
728,834.71 PEG BARU PER 1 PEB 2017
366,473.33 PEG BARU PER 22 MEI 2017
366,473.33 PEG BARU PER 22 MEI 2017
352,784.06 PEG BARU PER 22 MEI 2017
352,784.06 PEG BARU PER 22 MEI 2017
-
-
2,166,652.61
2,052,080.93
1,852,431.26 CUTI 31 MART - 30 JUNI 2016
1,616,385.55 CUTI 12 SEPT - 11 DES 2017
1,625,556.64
1,625,556.64
1,689,081.54
1,880,790.59

Page 119 of 248
KOMPER BY.UNIT
BY.KOM 25%
1,636,900.38 Pindah dr P.Mata per Juni 2017
1,652,781.60
1,374,860.19
1,335,157.13
1,335,157.13
1,499,641.23 CUTI 19 DES 2016 - 18 MART 2017
1,332,888.39 BARU PER 15 JUNI 2015
1,550,688.02
-
1,890,483.03 CUTI HAJI 18 AGTS - 26 SEP 2017
2,529,652.00
1,267,094.75 PEG BARU PER 11 JULI 2016
-
1,069,146.64
916,006.27
864,959.48
890,482.88
895,020.37
815,047.07
813,912.70
522,946.00 PEG BARU PER 1 JAN 2015
-
-
1,707,231.51
1,480,356.89
1,364,650.83
1,313,604.04
-
1,762,815.79
2,053,215.30
2,087,246.49

Page 120 of 248
KOMPER BY.UNIT
BY.KOM 25%
1,698,156.52
1,695,887.78
1,700,425.27
1,749,203.31
1,751,472.06
1,484,894.38
1,647,109.73
1,623,287.90
1,334,022.76
1,331,754.01
1,231,929.18
1,229,660.43
1,523,463.07
1,229,660.43
1,229,660.43
1,227,391.69
-
-
1,193,360.50
1,130,969.98 CUTI 14 APR - 14 MEI 2017
-
-
- PENSIUN PER 1 PEB 2017
1,509,850.59 CUTI BESAR 17 OKT 2016 - 17 JAN 2017
3,045,791.76
2,808,707.78
2,896,054.51
1,584,719.21
1,583,584.84
1,581,316.09
1,455,967.87
1,484,327.19
1,505,880.28
1,436,683.52

Page 121 of 248
KOMPER BY.UNIT
BY.KOM 25%
1,354,441.47
1,475,252.21
1,334,589.95
2,602,251.88
1,355,008.66
1,479,222.52
1,284,677.53
1,329,485.27
1,326,082.15 CUTI HAJI 17 SEPT - 17 OKT 2015
1,252,347.90
1,052,131.05 CUTI UMROH 15 - 27 PEB 2016
1,019,801.41 TUGAS BELAJAR PER JULI 2016
1,401,517.96
965,351.50
1,022,070.16
994,278.02
946,634.35 per des gaji 2,810,200
966,485.88 per des gaji 2,898,700
1,092,968.48 per des gaji 2,641,200
864,392.30 masuk agustus 2015
814,479.88
1,453,699.12
1,146,284.01
880,273.52 UMROH 19 - 28 DES 2016
914,304.71 UMROH 14 - 25 MART 2017
887,646.95 per des gaji 2,641,200
857,586.06
914,304.71 PENDIDIKAN PER 1 JULI 2015 - 1 JULI 2
1,402,652.33
942,096.85
866,661.04 CPNS
1,096,371.60
916,573.46 UMROH 26 DES 2015 - 5 JAN 2016
866,661.04 DIKLAT (3 BLN) 15 JAN 17- 15 APRIL 2017

Page 122 of 248
KOMPER BY.UNIT
BY.KOM 25%
797,464.29 CUTI 1 APR - 30 JUNI 2016
836,600.16 PEG BARU PER 2 PEB 2015
826,240.34 KELUAR PER 1 AGUSTUS 2017
950,604.65 PEG BARU PER 3 MARET 2015
836,600.16 CUTI HAJI 16 SEPT - 17 OKT 2015
836,600.16 PEG BARU PER 15 JUNI 2015
836,600.16 PEG BARU PER 15 JUNI 2015
836,600.16 PEG BARU PER 3 AGUST 2015
831,880.21 CUTI HAJI 18 AGTS - 26 SEP 2017
830,928.29 PEG BARU PER 14 SEPT 2015
828,092.36 PEG BARU PER 2 NOP 2015
830,928.29 PEG BARU PER 5 NOP 2015
826,240.34 KELUAR PER 1 SEPT 2017
836,600.16 PEG BARU PER 1 JUNI 2016
1,146,284.01 Per 1 Peb 2016
1,070,848.20 Per 1 Peb 2016
836,600.16 1 NOPEMBER 2014-31 APRIL 2015
1,074,818.51 PER 13 JUNI 2016
836,600.16 PEG BARU PER 1 AGUSTUS 2016
836,600.16 PEG BARU PER 1 AGUSTUS 2016
4,687.95 CUTI 1 MEI - 1 AGUS 2017
1,038,518.57 PEG BARU PER 1 AGUSTUS 2016
2,271.97 PEG BARU PER 1 AGUSTUS 2017 (50%)
-

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KOMPER BY.UNIT
BY.KOM 25%
-
117,378.40 104,693.56 931,012,626.50 -
931,012,626.50
0

Page 124 of 248
489,176,972.85
TIND. PERAWAT & PENUNJANG TUNJANGAN
BY. UNIT BY. KOMITE STRUKTURAL
50% 50% 5%
Diklat PIM 1/4/13 s/d 15/5/13

Plt. Wadir Per 1 Juni 2016
kabag per 1/8/12 12,413,501.69

PER 1/8/12 8,593,962.71
Diklat PIM 29 MEI - 3 JULI 2013 8,593,962.71
PER 1/4/15 8,593,962.71
Mutasi dari PDE per April 2013

CUTI 1 JUNI - 26 AGUST 2016
Pindah dr Radiologi per maret 2014

Mutasi ke TU per 1/10/13
CUTI 14 JAN - 13 APR 2013
Mutasi dr komdik per nov '12

per agust '11
BARU PER 1 APRIL 2013
BARU PER 2 JAN 2014
BARU PER 1 JAN 2014
BARU PER 26 JAN 2015
PEG BARU PER 7 DES 2015

Page 125 of 248
489,176,972.85
50% 50% 5%
Pindah TU per 1 Jan 2016
PEG BARU PER 1 PEB 2017
12,413,501.69
8,593,962.71
per maret 2012 8,593,962.71
CUTI 11 JULI - 10 OKT 2016
CUTI 11 JULI - 1 SEP 2016
per agust '11

CUTI 9 NOP 2012 - 8 PEB 2013
Baru per 1 peb 2014
Baru per 1 peb 2014
Baru per 2 April 2014
per agust '11

Page 126 of 248
489,176,972.85
50% 50% 5%
12,290,550.69
8,631,793.78
8,593,962.71
CUTI 25 NOP 2013 - 24 PEB 2014
CUTI 26 MEI - 25 AGUST 2014
CUTI 7 APR - 6 JULI 2014

CUTI 22 DES 2014 - 21 MART 2015
pindah dr Gizi per Juli 2012

BARU PER 9 JAN 2014
BARU PER 23 JUNI 2014
PEG BARU PER 1 NOP 2015

Page 127 of 248
489,176,972.85
50% 50% 5%
mutasi di keu per jan '13
CUTI 9 OKT 2014 - 8 JAN 2015

UMROH 16 - 30 MARET 2013
CUTI HAJI 1 SEP- 31 OKT 2015
CUTI UMROH 20 JAN - 1 PEB 2014
Baru percobaan 1 Juni '13

PEG BARU PER 11 JULI 2016
per agust '11
Pindah dr IKF per Maret 2014
CUTI 26 JAN - 26 MART 2015
per jan 2013

PEG BARU PER 13 APRIL 2016
12,413,501.69
CPNS PER APRIL 2011 8,593,962.71
KASUBID RAWAT DARURAT PER 15 MEI 2014 8,593,962.71
Pindah dr Poli THT per Maret 2014

Page 128 of 248
489,176,972.85
50% 50% 5%
BARU PER 2 April 2014
PEG BARU PER 7 MARET 2016
12,413,501.69
8,593,962.71
8,593,962.71
UMROH 8 - 20 MART 2017
Pindah Per 1 Juni 2016
12,413,501.69
KASUBID SDM ASKEP PER 12/8/13 8,593,962.71
KASUBID IRNA PER 1/6/14 8,593,962.71
PEG BARU PER 1 NOP 2016
CUTI HAJI 13 SEPT - 11 NOP 2013 233,357.40 1,400,120.81

206,816.75 1,240,879.60
180,676.72 1,084,042.04
CUTI 14 JAN - 13 MAR 2013 171,462.61 1,028,758.29
40,436.93 970,470.00
CUTI 10 APR - 17 JULI 2015 134,806.46 808,825.15
129,898.95 779,380.55

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489,176,972.85
50% 50% 5%
CUTI 20 AGUST - 19 NOP 2016 134,606.16 807,623.33
CUTI 17 DES 2015 - 17 MART 2016 146,023.64 876,127.10
per agust '11 125,592.35 753,541.41
Pindah dr IGD per 1 Des 2014 130,099.26 780,582.37
Pindah dr Poli anak per 1 Mei 2015 135,407.39 812,430.62
PEG BARU PER 7 MARET 2016 120,684.84 724,096.81
BARU PER 1 APRIL 2013 125,191.74 751,137.77
116,177.93 697,055.85
116,177.93 697,055.85
116,177.93 697,055.85
1,729,120.06 1,356,855.27
1,732,183.16 1,359,258.92
1,384,521.28 1,086,445.68
1,315,601.53 1,032,363.76
317,413.76 996,309.14
227,818.08 715,083.16
1,317,133.08 1,033,565.58
Pinjaman dri R.B 12 Apr - 12 Juli 2012 1,312,538.43 1,029,960.12
Pinjaman dri R.B 30 Apr - 21 Mei 2012 317,796.64 997,510.96
PNS BARU PER 1 NOP 2016 1,030,733.21 808,825.15
Mutasi dari IGD per 1/6/13 1,033,796.31 811,228.80
1,033,796.31 811,228.80
999,336.44 784,187.84
1,032,264.76 810,026.98
CPNS PER APRIL 2011 1,140,239.04 894,755.32
CPNS PER APRIL 2011 1,104,247.62 866,512.54
dipinjam IGD per 14 Mart - 17 Juni 2015 997,804.89 782,986.02
CUTI 1 DES 2012 - 1 MAR 2013 997,804.89 782,986.02
CUTI 22 AGUST - 21 NOP 2013 - 754,743.24
CUTI 23 SEPT -22 DES 2013 963,345.01 755,945.06
Pinjaman dri R.B 12 Jan - 11 Mart 201 996,273.34 781,784.19
961,813.46 754,743.24

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489,176,972.85
50% 50% 5%
BARU PER 1 APRIL 2013 961,813.46 754,743.24
PEG BARU PER 7 DES 2015 922,758.93 724,096.81
PEG BARU PER 13 APRIL 2016 922,758.93 724,096.81
BARU PER 4 AGUST 2014 925,822.03 726,500.45
Pinjaman R.B 18/2 - 17/4 2017 925,822.03 726,500.45
-
-
2,100,744.02 1,523,307.41
1,879,482.22 1,362,864.38
1,757,663.93 1,274,530.57
1,514,027.34 1,097,862.97
1,509,055.17 1,094,257.51
CUTI 18 MEI - 17 AGUS 2015 1,471,763.85 1,067,216.55
CUTI 1 MEI - 1 AGUST 2015 1,478,393.42 1,072,023.83
1,441,102.11 1,044,982.87
CUTI 15 DES 2013 - 14 MART 2014 1,471,763.85 1,067,216.55
1,444,416.89 1,047,386.51
1,436,129.93 1,041,377.41
1,510,712.56 1,095,459.33
334,585.96 970,470.00
1,127,855.07 817,838.81
198,265.49 575,071.08
CUTI 21 OKT 2013 - 20 JAN 2014 1,126,197.68 816,636.99
per agust '11 1,209,067.27 876,728.01
CUTI 5 SEPT - 4 DES 2014 1,087,248.97 788,394.21
CUTI 6 PEB - 5 MEI 2015 1,088,906.37 789,596.03
per agust '11 - 882,737.11
BARU PER 1 APRIL 2013 1,087,248.97 788,394.21
1,011,008.95 733,110.47
1,011,008.95 733,110.47
1,139,456.81 826,251.55
1,011,008.95 733,110.47
-

Page 131 of 248
489,176,972.85
50% 50% 5%
-
1,535,712.75 1,538,330.16
BARU PER 1 JAN 2015 (penempatan R.F 928,626.31 930,209.02
BARU PER 1 JAN 2015 (penempatan P.Pa 969,418.68 971,070.91
959,820.47 961,456.35
CUTI 23 MEI - 4 JUNI 2016 248,953.43 997,510.96
235,455.96 943,429.04
CPNS PER APRIL 2011 865,038.20 866,512.54
152,971.39 612,928.42
CUTI 24 NOP 2013 - 23 JAN 2014 807,448.97 808,825.15
807,448.97 808,825.15
779,254.25 780,582.37
779,254.25 780,582.37
143,523.15 575,071.08
Pindah dr IGD per 1 Mei 2014 779,254.25 780,582.37
BARU PER 4 AGUST 2014 722,864.79 724,096.81
PEG BARU PER 7 DES 2015 722,864.79 724,096.81
BARU PER 4 AGUST 2014 812,248.07 813,632.44
695,869.84 697,055.85
695,869.84 697,055.85
-
-
Mutasi dari R.ICU per 1/6/13 1,603,127.60 1,591,210.26
CUTI UMROH 20 - 31 JAN 2014 1,317,373.74 1,307,580.64
1,040,095.63 1,032,363.76
237,623.71 943,429.04
250,942.75 996,309.14
814,882.84 808,825.15
814,882.84 808,825.15
814,882.84 808,825.15
144,844.52 575,071.08

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489,176,972.85
50% 50% 5%
813,672.01 807,623.33
CUTI 14 SEPT - 13 DES 2015 813,672.01 807,623.33
CUTI 15 OKT 2015 - 14 JAN 2016 813,672.01 807,623.33
CUTI 21 NOP 2015 - 20 PEB 2016 813,672.01 807,623.33
BARU PER 1 APRIL 2013 851,812.89 845,480.68
BARU PER 4 AGUST 2014 731,941.57 726,500.45
PEG BARU PER 7 DES 2015 729,519.92 724,096.81
PEG BARU PER 7 DES 2015 730,730.75 725,298.63
PEG BARU PER 13 APRIL 2016 729,519.92 724,096.81
796,115.10 790,196.94
796,115.10 790,196.94
702,276.44 697,055.85
702,276.44 697,055.85
702,276.44 697,055.85
702,276.44 697,055.85
702,276.44 697,055.85
796,115.10 790,196.94
-
-
1,290,724.99 1,292,557.88
CUTI 14 DES 2012 - 12 MAR 2013 1,002,697.10 1,004,120.98
1,000,296.86 1,001,717.34
CUTI 8 OKT 2013 - 7 JAN 2014 1,000,296.86 1,001,717.34
CUTI 28 OKT 2015 - 27 JAN 2016 974,494.37 975,878.20
CUTI 23 MEI - 22 AGUST 2016 778,275.36 779,380.55
CUTI 15 DES 2016 - 14 PEB 2017 723,070.02 724,096.81
BARU PER 1 SEPT 2014 811,278.56 812,430.62
PEG BARU PER 7 DES 2015 723,070.02 724,096.81
Pindah dr R.B per Maret '14 242,273.46 970,470.00
BARU PER 1 APRIL 2013 844,281.76 845,480.68
789,076.41 790,196.94
696,067.40 697,055.85
696,067.40 697,055.85

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489,176,972.85
50% 50% 5%
696,067.40 697,055.85
696,067.40 697,055.85
-
-
Pindah dr Poli.VIP per 1 mei 2015 462,387.46 1,376,084.40
Pindah dr IGD per 1 Des 2014 417,764.04 1,243,283.24
346,083.89 1,029,960.12
CPNS PER APRIL 2011 291,162.76 866,512.54
CPNS PER APRIL 2011 290,758.93 865,310.72
Mutasi dr. R.C per Nop 2014 81,523.55 970,470.00
74,204.10 883,338.02
CUTI 14 PEB - 13 MEI 2014 262,692.61 781,784.19
262,692.61 781,784.19
271,778.83 808,825.15
Mutasi dari Poli VIP per 9/10/12 51,084.73 608,121.14
Pindah dr Poli Jantung per Maret 2014 243,712.52 725,298.63
BARU PER 1 APRIL 2013 252,798.73 752,339.59
BARU PER 1 APRIL 2013 252,798.73 752,339.59
271,375.00 807,623.33
BARU PER 1 APRIL 2013 284,095.70 845,480.68
Baru per 1 peb 2014 243,308.69 724,096.81
PEG BARU PER 7 DES 2015 243,308.69 724,096.81
PEG BARU PER 7 DES 2015 - 724,096.81
PEG BARU PER 7 DES 2015 243,308.69 724,096.81
PEG BARU PER 7 DES 2015 243,308.69 724,096.81
-
- -
439,787.05 1,084,042.04
327,646.23 807,623.33
328,133.80 808,825.15
328,133.80 808,825.15
328,133.80 808,825.15
320,576.48 790,196.94
320,576.48 790,196.94

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489,176,972.85
50% 50% 5%
282,789.90 697,055.85
320,576.48 790,196.94
320,576.48 790,196.94
-
-
482,982.89 1,437,377.24
336,997.67 1,002,919.16
76,879.49 915,186.26
CUTI 1 DES 2015 - 1 MART 2016 271,375.00 807,623.33
244,116.35 726,500.45
271,778.83 808,825.15
271,375.00 807,623.33
265,519.44 790,196.94
234,222.47 697,055.85
PEG BARU PER 1 NOP 2016 - 790,196.94
- 575,071.08
234,222.47 697,055.85
-
-
Pindah dr R.F Per 1 des 14 1,563,805.86 1,373,680.76
1,140,360.62 1,001,717.34
275,855.08 969,268.18
CUTI 26 MEI - 25 AGUS 2014 986,442.72 866,512.54
Pindah dr. R.D per juli 2013 1,143,096.94 1,004,120.98
887,251.18 779,380.55
920,771.08 808,825.15
163,666.03 575,071.08
888,619.34 780,582.37
CUTI 5 MART - 4 JUNI 2014 888,619.34 780,582.37
per agust '11 856,467.60 752,339.59
Baru per 1 peb 2014 825,684.02 725,298.63
BARU PER 4 AGUST 2014 824,315.86 724,096.81
899,564.61 790,196.94

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489,176,972.85
50% 50% 5%
793,532.28 697,055.85
899,564.61 790,196.94
793,532.28 697,055.85
793,532.28 697,055.85
-
-
1,174,630.63 1,407,331.73
1,101,404.29 1,319,598.84
CUTI HAJI 25 AGTS - 25 OKT 2014 202,250.13 969,268.18
CPNS PER APRIL 2011 737,278.83 883,338.02
Pindah dr IGD per 1/5/14 805,991.21 998,712.78
CUTI 7 JUNI - 5 SEPT 2014 833,576.47 965,662.72
119,995.89 575,071.08
743,297.43 890,548.94
690,133.11 826,852.46
689,130.01 825,650.64
Pindah dr Poli Anak per 1 Des 2014 689,130.01 825,650.64
PEG BARU PER 7 DES 2015 620,417.63 743,325.94
596,844.77 715,083.16
596,844.77 715,083.16
596,844.77 715,083.16
596,844.77 715,083.16
-
-
- 1,346,639.80
PEG BARU PER 1 JUNI 2016 788,875.67 922,998.10
870,536.63 1,018,542.82
CUTI 1 JAN - 1 APR 2015 906,487.99 1,060,606.54
195,549.75 915,186.26
690,266.21 807,623.33
667,154.62 780,582.37
CUTI 14 OKT 2013 - 13 JAN 2014 666,127.44 779,380.55
667,154.62 780,582.37

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489,176,972.85
50% 50% 5%
BARU PER 4 AGUST 2014 - 725,298.63
PEG BARU PER 7 DES 2015 619,904.25 725,298.63
PEG BARU PER 7 DES 2015 618,877.07 724,096.81
675,372.07 790,196.94
595,765.48 697,055.85
595,765.48 697,055.85
PEG BARU PER 7 DES 2015 618,877.07 724,096.81
PEG BARU PER 1 NOP 2016 675,372.07 790,196.94
129,938.51 608,121.14
-
-
3,252,485.89 1,567,173.85
2,927,446.10 1,373,680.76
UMROH 5 - 18 PEB 2014 3,089,617.99 1,416,345.39
2,764,578.20 1,362,263.47
2,927,446.10 1,272,126.93
2,927,446.10 1,355,653.45
2,927,446.10 1,229,462.31
2,927,446.10 1,282,342.41
2,927,446.10 1,242,682.33
Pindah dr IGD per 1/2/14 2,601,710.30 1,181,389.49
2,601,710.30 1,117,693.01
2,439,538.42 1,041,377.41
UMROH 9 - 23 MEI 2014 2,439,538.42 1,063,611.09
2,439,538.42 1,046,184.69
2,764,578.20 1,070,822.01
1,625,894.93 997,510.96
Diklat 3 bulan mulai juli-sep '13 2,601,710.30 1,095,459.33
1,625,894.93 996,309.14
2,276,670.52 927,204.47
baru per okt '12 2,276,670.52 981,286.39
2,276,670.52 1,073,225.65
1,138,683.27 695,253.12

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489,176,972.85
50% 50% 5%
1,138,683.27 695,253.12
1,138,683.27 695,253.12
CUTI 16 JUNI - 16 AGUST 2014 1,138,683.27 608,121.14
Pindah dr R.C per Juli 2013 2,276,670.52 842,476.13
2,276,670.52 918,190.81
1,951,630.74 761,353.25
PEG BARU PER 7 DES 2015 1,951,630.74 761,353.25
PEG BARU PER 1 NOP 2016 1,951,630.74 734,312.29
-
-
2,052,406.09 1,583,999.34
CUTI UMROH 20 JAN - 1 PEB 2014 1,991,878.01 1,388,703.52
1,688,733.25 1,337,626.15
1,688,733.25 1,250,494.17
1,870,569.67 1,273,328.75
1,810,041.59 1,123,702.11
1,870,569.67 1,022,749.19
1,810,041.59 1,208,430.45
Pindah IBS (RR) per 1 Mei 2015 1,628,205.17 1,011,932.81
Tugas belajar per Oktober 2012 s/d 1 Apr 1,870,569.67 1,043,781.05
1,629,718.38 1,036,570.13
1,810,041.59 1,043,781.05
1,749,261.32 1,015,538.27
Diklat 1 tahun mulai bl. Juli 2011 s/d 20 1,749,261.32 1,043,781.05
-
-
CUTI 19 APR - 18 JULI 2014

Karu per 1/6/13 1,414,427.29 1,284,746.05

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489,176,972.85
50% 50% 5%
1,404,503.80 1,275,732.39
1,291,376.08 1,172,976.75
1,336,362.54 1,213,838.64
Tugas belajar mulai 1 sept 2011 s/d sep 1,208,680.38 1,097,862.97
1,269,544.42 1,153,146.71
1,268,221.29 1,151,944.89
1,146,493.21 1,041,377.41
1,176,263.67 1,068,418.37
Pindah dr R.D per juli 2013 - 1,035,368.31
Pindah dr R.H per juli 2013 994,994.69 903,768.97
Pindah dr R.H per Maret 2014 992,348.42 901,365.33
274,880.51 998,712.78
CUTI 14 DES 2013 - 13 MARET 2014 931,484.39 846,081.59
CUTI 26 MART - 25 JUNI 2014 930,161.26 844,879.77
900,390.80 817,838.81
899,067.67 816,636.99
1,338,347.24 1,215,641.37
Pindah dr R.IBS (OK) per juli 2013 930,161.26 844,879.77
PEG BARU PER 7 DES 2015 842,173.03 764,958.71
909,652.72 826,251.55
909,652.72 826,251.55
807,110.05 733,110.47
PEG BARU PER 22 MEI 2017 807,110.05 733,110.47
-
-
1,107,923.70 1,309,383.37
TKHI 10 SEPT - 10 NOP 2013 1,070,298.02 1,264,916.01
995,555.12 1,176,582.21
Pindah dr IBS per 1/2/14 1,066,230.38 1,260,108.73
1,076,399.49 1,272,126.93
TKHI 10 SEPT - 10 NOP 2013 924,879.86 1,093,055.69
Pindah dr R.b per 1 Des 2014 905,050.11 1,069,620.19
879,118.90 1,038,973.77
877,085.08 1,036,570.13

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489,176,972.85
50% 50% 5%
Pindah dr R.H per 1 Des 2014 879,118.90 1,038,973.77
901,999.38 1,066,014.73
877,085.08 1,036,570.13
205,288.75 970,470.00
147,070.64 695,253.12
689,973.60 815,435.17
per agust '11 667,093.12 788,394.21
CUTI 27 AGUST - 26 NOP 2014 193,594.29 915,186.26
Mutasi dr Komdik per 9/10/12 147,070.64 695,253.12
CPNS PER APRIL 2011 765,733.41 904,970.79
Pindah dr Poli vip juli 2013 689,973.60 815,435.17
Pindah dr R.A per 1 Mei 2014 690,990.51 816,636.99
Pindah dr R.H per 1 Mei 2014 741,836.02 876,728.01
Pindah dr R.D per 1 Des 2014 667,093.12 788,394.21
Pindah dr R.G per 1 Des 2014 668,110.03 789,596.03
BARU PER 23 JUNI 2014 129,910.28 614,130.24
Mutasi dr PDE Per 29 Des 2014 179,484.66 848,485.23
BARU PER 4 AGUST 2014 645,229.55 762,555.07
BARU PER 4 AGUST 2014 no.25 645,229.55 762,555.07
714,887.90 844,879.77
690,990.51 816,636.99
Pindah dr IGD per 1/5/14 690,990.51 816,636.99
dipinjam R.WK. per 8 Juli - 17 Agust 201 667,093.12 788,394.21
Baru per 1 Mart 2014 644,212.64 761,353.25
BARU PER 5 SEPT 2014 717,938.63 848,485.23
CUTI 12 MART - 11 JUNI 2015 717,938.63 848,485.23
CUTI 15 JULI - 14 OKT 2015 669,126.94 790,797.85
CUTI 10 JUNI - 9 SEPT 2015 668,110.03 789,596.03
668,110.03 789,596.03
742,852.93 877,929.83

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489,176,972.85
50% 50% 5%
690,990.51 816,636.99
620,315.24 733,110.47
-
-
- 1,222,251.39
7,998,183.48 1,091,252.96
Pindah dr R.G per 1 Des 2014 8,341,717.79 1,138,123.95
Diklat 28 Peb -29 Jun 2012 7,773,564.89 1,060,606.54
8,707,273.54 1,187,999.50
7,755,947.75 1,058,202.90
Diklat 28 Peb -29 Jun 2012 7,584,180.59 1,034,767.40
TKHI 10 SEPT - 10 NOP 2013 7,976,162.05 1,088,248.41
7,791,182.04 1,063,010.18
7,808,799.18 1,065,413.82
7,170,177.70 978,281.84
5,756,401.88 785,389.66
1,224,391.52 668,212.16
5,567,017.58 759,550.52
-
-
1,042,084.94 1,416,946.30
CUTI HAJI 8 SEPT - 2 NOP 2014 908,178.35 1,234,870.50
DIKLAT 15 JAN (3 BLN) 15 JAN 17- 15 A 723,449.13 983,690.03
122,858.19 668,212.16
-
-
212,468.40 1,317,195.20
CUTI 8 NOP 2014 - 7 PEB 2015 129,594.10 803,416.96
-
-
CUTI 5 AGUST - 5 NOP 2014 127,400.00 1,019,744.64
-
-
484,140.47 1,413,340.84

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489,176,972.85
50% 50% 5%
UMROH 21 APR - 6 MEI 2014 446,883.06 1,304,576.09
349,519.78 1,010,730.99
Pindah dr R.H per Maret 2014 346,226.30 1,020,345.55
CUTI 7 JUNI - 5 SEPT 2014 -
-
717,377.01 1,277,535.13
CUTI 29 MEI - 15 AGUST 2016 433,935.49 772,770.54
-
-
CUTI UMROH 20 JAN - 1 PEB 2014 1,010,145.66 1,419,950.85
Mutasi dari R.D per 1/11/13 917,809.03 1,290,154.24
Pindah dari R.G per Nop '14 725,441.04 1,019,744.64
Pindah dari R.G per Nop '12 705,349.27 991,501.86
-
-
572,723.90 1,306,979.73
529,275.88 1,207,829.54
Pindah dr Poli Bedah per 1 Des 2014 482,404.69 1,100,867.52
375,232.90 856,297.06
Pindah dr R.ICU per Juli 2013 410,254.64 936,218.12
450,016.16 1,026,955.56
Mutasi dari HD per 10 Peb 2012 445,803.02 1,017,341.00
-
-
636,586.96 1,384,497.14
542,369.88 1,179,586.76
446,218.72 970,470.00
Pindah dr R.H per 1/4/13 444,560.94 966,864.54
-
-
840,078.87 1,345,437.98
686,620.96 1,099,665.70
Pindah dr R.F per Maret 2014 604,451.57 968,066.36
Pindah dr R.Nicu per juli 2013 622,086.10 996,309.14

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489,176,972.85
50% 50% 5%
-
-
1,290,251.31 1,293,759.70
987,614.57 990,300.04
CUTI 1 JULI 2014 - 30 SEP 2014 825,808.78 828,054.28
Pinjaman dari PDE 30 Juni - 29 Sept 201 768,277.84 770,366.90
Pindah dr P.Anak per 1 Juni 2017 - 992,703.68
NEGARA PER 1 JAN 2015 (2 THN) - -
PEG BARU PER 1 NOP 2016 659,208.75 661,001.24
-
-
342,099.69 1,347,841.62
326,847.81 1,287,750.60
-
-
824,312.94 1,377,286.22
pindah dr R.B per 3/3/14 710,304.56 1,186,797.68
-
-
118,794.85 1,304,576.09
90,505.15 993,905.50
-
-
1,786,826.80 1,236,072.32
1,412,435.77 977,080.02
221,941.78 614,130.24
994,611.90 688,042.20
-
-
Pindah dr R.F per juli 2013 190,148.16 1,552,752.01
Dipinjamkan dr R.C per 1 Nop '13 - 31 Jan 148,056.54 1,209,031.36
Pindah dr R.C per Maret '14 28,882.80 943,429.04
-
-

Page 143 of 248
489,176,972.85
50% 50% 5%
Pindah Per Sept 2014 267,454.21 1,374,882.58
171,133.29 879,732.56
-
-
Pindah dr R.ICU per Maret 2014 - 1,017,341.00
10,976.91 688,042.20
11,935.59 748,133.22
-
-
2,278,526.25 1,323,204.30
1,519,017.50 999,914.60
1,670,919.25 1,026,955.56
2,126,624.50 771,568.72
CUTI 28 JUNI - 27 SEPT 2014 - 716,284.98
per agust '11 1,898,771.88 716,284.98
per agust '11 1,063,312.25 641,171.20
BARU PER 23 JUNI 2014 1,063,312.25 767,362.35
1,291,164.88 689,244.02
1,139,263.13 688,042.20
1,139,263.13 688,042.20
-
-
CUTI 26 MART - 25 JUNI 2014 1,711,250.00 828,054.28
Diklat 17 Mart - 17 Mei 2014 / Mutasi dr L 1,711,250.00 832,861.56
- 661,001.24
-
-
702,975.00 1,305,777.91
-
-
61,240.78 1,084,642.95
Mutasi dari IPL per 1/6/13 13,342.35 945,231.77
46,549.78 824,448.82
46,549.78 824,448.82

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489,176,972.85
50% 50% 5%
per agust '11 9,957.99 705,468.60
PEG BARU PER 2 APR 2014 9,559.33 677,225.82
-
-
972,774.05 1,314,190.65
583,664.43 1,022,148.28
856,041.16 1,121,298.47
Tugas belajar per Oktober 2012 s/d Peb 747,090.47 1,053,996.52
583,664.43 1,131,513.94
583,664.43 964,460.90
CPNS per 8 Maret 2010 692,615.12 937,419.94
CPNS per 8 Maret 2011 583,664.43 937,419.94
428,020.58 1,022,148.28
428,020.58 772,770.54
Pindah dr TU per Maret 2014 389,109.62 910,378.98
PEG BARU PER 1 NOP 2014 428,020.58 743,325.94
505,842.50 742,124.12
- -
-
-
1,472,926.51 1,383,896.23
1,031,048.56 1,432,569.96
UMROH 8 - 22 APR 2014 1,178,341.21 1,191,004.05
1,031,048.56 1,082,840.21
1,031,048.56 1,054,597.43
1,031,048.56 1,059,404.72
883,755.90 1,028,758.29
883,755.90 999,313.69
883,755.90 1,029,960.12
883,755.90 1,027,556.47
883,755.90 1,000,515.51
883,755.90 918,190.81
1,031,048.56 1,068,418.37
810,109.58 802,215.14

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489,176,972.85
50% 50% 5%
CPNS PER APRIL 2011 736,463.25 891,149.85
883,755.90 806,421.51
883,755.90 806,421.51
883,755.90 779,380.55
883,755.90 780,582.37
CUTI 25 JAN - 24 APR 2014 736,463.25 725,298.63
736,463.25 725,298.63
Baru per 5 Maret 2014 736,463.25 725,298.63
736,463.25 724,096.81
736,463.25 724,096.81
736,463.25 639,969.38
736,463.25 697,055.85
736,463.25 697,055.85
- -
- -
883,755.90 1,231,265.04
736,463.25 782,986.02
CUTI 15 JUNI - 14 SEPT 2014 736,463.25 755,945.06
Baru per 5 Juni 2014 736,463.25 726,500.45
- 697,055.85
Mutasi dari Poli PA per 1/8/13

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489,176,972.85
50% 50% 5%
Mutasi dari IPL per 1/6/13

Mutasi dari IPL per 1/6/13
per agust '11

per agust '11
per agust '11
Tugas belajar per Oktober 2012 s/d 2013 (Agust '13 Masuk)

Page 147 of 248
489,176,972.85
50% 50% 5%
CPNS PER APRIL 2011
CPNS PER APRIL 2011
CUTI 29 OKT 2012 - 28 JAN 2013
per agust '11

per agust '11
CUTI 13 MEI - 13 JUNI 2013 / BARU
PEG BARU PER 2 APR 2014
PEG BARU PER 2 APR 2014
PEG BARU PER 23 JUNI 2014
Pindah dr IPS per Maret 2014
Mutasi ke loundry per 1/6/13

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489,176,972.85
50% 50% 5%
1,188,600.41
1,303,975.18
1,206,627.72
UMROH 29 JAN - 7 PEB 2014 1,028,758.29
1,005,923.71
1,160,958.54
1,086,445.68
1,105,674.80
UMROH 27 DES 2013 - 2 JAN 2014 1,037,771.95
978,281.84
889,347.12
CUTI 26 AGUSTUS - 27 NOPEMBER 2014 925,401.74
CUTI 10 JUNI - 9 SEPT 2014 942,227.22
870,118.00
899,562.60
897,158.96
916,388.08
871,319.82
870,118.00
961,456.35
879,131.65
835,265.20
834,063.38
835,265.20
CPNS PER APRIL 2011 900,163.51
CUTI 11 MART - 10 JUNI 2014 855,095.24

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489,176,972.85
50% 50% 5%
Mutasi dari IPL per 19/9/12 784,187.84
817,237.90
863,507.98
CUTI 30 MEI - 29 AGUST 2014 864,709.81
CUTI 8 AGUST - 30 SEPT 2014 (OKT MASUK) 743,325.94
743,325.94
704,266.78
722,294.08
CUTI 5 PEB - 4 APR 2014 704,266.78
743,325.94
650,184.86
668,212.16
per jan 2013 650,184.86
BARU PER 1 APRIL 2013 650,184.86
650,184.86
PEG BARU PER 15 JUNI 2015 833,462.47
781,183.28
800,412.41
772,169.63
772,169.63
772,169.63
743,325.94
743,325.94
CUTI 12 MEI - 11 AGUS 2014

CPNS PER APRIL 2011

Page 150 of 248
489,176,972.85
50% 50% 5%

BARU PER 26 JAN 2015
per nov '11
Pindah dr IPS per 1/2/14

Page 151 of 248
489,176,972.85
50% 50% 5%
7 JAN 2017
MASUK BLN JULI '11
MASUK BLN APRIL '11
Pindah Fungsional per 16/5/14

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489,176,972.85
50% 50% 5%
JULI '11
PER april '14 KEBERSAMAAN DAPAT
TKHI 10 SEPT - 10 NOP 2013

CUTI HAJI 1 SEPT - 31 OKT 2014
CUTI HAJI 1 SEPT - 27 OKT 2014
CPNS PER 1 SEPT 2014

penghadapan tgl 25 Agust 2011
Masuk per 5 April 2012
UMROH 18 - 26 PEB 2014
SK per 1 Jun 2012
per des gaji 2,810,200

per des gaji 2,724,400
Baru per 1 April '13
PEG BARU PER 1/12/13
CUTI 5 JUNI - 31 JULI 2014
PEG BARU PER 5/6/14
PEG BARU PER 5 AGUST 2014
PEG BARU PER 5 AGUST 2014
5 APRIL 2017

Page 153 of 248
489,176,972.85
50% 50% 5%
PEG BARU PER 1 JAN 2015
PEG BARU PER 15 JUNI 2015
CUTI 1 APR - 30 JUNI 2017
PEG BARU PER 1 AGUSTUS 2016
2017 (50%)
2017 (50%)
2017 (50%)

Page 154 of 248
489,176,972.85
50% 50% 5%
3,500,000.00
1,650,000.00
489,176,972.85 489,176,972.85 186,117,405.38
489,176,972.85 489,176,972.85 186,117,405.38

(0.00) - (0.00)

Page 155 of 248
TINDAKAN DOKTER POLI VIP TOTAL % PJK PAJAK
NON VIP LAIN-LAIN BRUTO PER GOL PNS
SEPTEMBER '17 SEPTEMBER '17
111,721,515.18 2,772,466.92 114,493,982.10 15% 17,174,097.32

37,240,505.06 924,155.64 38,164,660.70 15% 5,724,699.11
37,240,505.06 924,155.64 38,164,660.70 15% 5,724,699.11
-
-
12,413,501.69 15% 1,862,025.25
8,593,962.71 5% 429,698.14
8,593,962.71 5% 429,698.14
8,593,962.71 5% 429,698.14
2,466,127.11 5% 123,306.36
2,138,293.28 5% 106,914.66
1,832,012.55 5% 91,600.63
1,953,390.47 5% 97,669.52
1,668,662.82 -
1,866,043.74 -
1,664,125.33 -
2,008,974.75 -
1,557,494.26 -
1,535,941.17 -
1,586,987.96 -
1,584,719.21 -
1,638,034.75 -
1,351,038.36 -
1,482,625.63 -
1,586,987.96 -
1,484,894.38 -
1,028,876.40 -
1,433,847.59 -
1,142,313.71 -
1,142,313.71 -
8,063.91

Page 156 of 248
1,635,766.00 -
1,378,263.31
-
-
12,413,501.69 15% 1,862,025.25
8,593,962.71 15% 1,289,094.41
8,593,962.71 15% 1,289,094.41
2,259,671.20 5% 112,983.56
2,367,436.65 5% 118,371.83
1,795,712.61 5% 89,785.63
1,982,884.17 5% 99,144.21
1,951,121.72 5% 97,556.09
1,886,462.46 5% 94,323.12
1,614,212.91 -
1,733,322.09 -
1,812,728.20 -
1,846,759.40 -
1,795,712.61 -
1,897,806.19 -
1,661,856.58 -
1,659,587.84 -
1,693,619.03 -
1,659,587.84 -
1,586,987.96 -
1,635,766.00 -
1,584,719.21 -
1,454,266.31 -
1,695,887.78 -
1,318,141.54 -
1,589,256.71 -
1,465,610.04
-
1,465,610.04
1,518,925.57 -

Page 157 of 248
-
-
12,290,550.69 15% 1,843,582.60
8,631,793.78 5% 431,589.69
8,593,962.71 5% 429,698.14
2,074,768.39 5% 103,738.42
1,684,544.05 5% 84,227.20
1,948,852.98 -
1,763,950.16 -
1,849,028.14 -
1,978,346.68 5% 98,917.33
1,763,950.16 -
1,712,903.37 -
1,693,619.03 -
1,610,809.79 -
1,480,356.89 -
- -
1,537,427.43 -
1,546,150.53 -
1,529,134.93 -
1,817,265.70 -
1,817,265.70 -
1,868,312.49 -
2,016,915.36 5% 100,845.77
1,369,188.33 -
1,369,188.33 -
1,351,038.36 -
1,331,754.01 -
1,329,485.27 -
1,318,141.54
1,337,425.88
1,152,788.58
1,284,110.34
1,142,313.71

Page 158 of 248
1,267,094.75
2,493,352.06 5% 124,667.60
2,206,355.67 5% 110,317.78
1,897,806.19 -
2,033,930.96 5% 101,696.55
1,846,759.40 -
1,744,665.82 -
1,846,759.40 -
1,591,525.45 -
1,593,794.20 -
1,227,391.69
1,429,310.10
1,352,172.73 -
1,227,391.69 -
1,295,454.07 -
2,046,409.06 5% 102,320.45
1,800,250.10 -
1,518,925.57 -
1,516,656.83 -
1,227,391.69 -
1,301,125.94 -
1,176,344.90 -
1,174,076.15
1,174,076.15
1,088,998.17
- -
- -
12,413,501.69 5% 620,675.08
113,750.00 8,707,712.71 5% 435,385.64
8,593,962.71 5% 429,698.14
2,104,262.09 5% 105,213.10
1,814,996.95 -
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1,433,847.59 -
1,431,578.85
1,429,310.10
-
- -
12,413,501.69 15% 1,862,025.25
8,593,962.71 5% 429,698.14
8,593,962.71 5% 429,698.14
1,661,856.58 -
1,610,809.79 -
1,638,034.75 -
- -
- -
12,413,501.69 15% 1,862,025.25
8,593,962.71 5% 429,698.14
8,593,962.71 5% 429,698.14
1,863,774.99 -
1,642,572.24 -
1,391,875.79
-
-
2,370,839.77 5% 118,541.99
2,126,949.55 5% 106,347.48
1,429,310.10
1,213,779.21
-
- -
2,955,022.87 5% 147,751.14
2,618,936.58 5% 130,946.83
2,287,923.28 5% 114,396.16
2,171,244.27 -
1,926,913.21 -
1,707,064.71 -
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1,704,528.21 -
1,849,108.73 -
1,590,385.70 -
1,647,456.95 -
1,714,674.21
1,528,241.44
1,585,312.70
1,471,170.18
1,144,057.96
1,144,057.96
- -
- -
4,366,682.55 5% 218,334.13
4,374,418.04 5% 218,720.90
3,496,440.24 5% 174,822.01
3,322,391.77 -
2,254,118.20 -
1,617,853.23 -
3,326,259.52 5% 166,312.98
3,314,656.29 5% 165,732.81
2,256,837.28 -
2,602,991.46
2,610,726.95 -
2,610,726.95 -
2,523,702.72 -
2,606,859.20 -
2,879,535.13 -
2,788,643.15 -
2,519,834.97 -
2,519,834.97 -
1,463,110.38
2,432,810.74 -
2,515,967.23 -
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2,428,943.00
2,341,918.77
2,330,315.53
2,330,315.53
2,338,051.02
2,338,051.02
- -
- -
5,061,869.32 15% 759,280.40
4,528,725.69 15% 679,308.85
4,235,197.17 5% 211,759.86
3,648,140.14 5% 182,407.01
3,636,159.38 5% 181,807.97
3,546,303.71 5% 177,315.19
3,562,278.05 5% 178,113.90
3,472,422.38 5% 173,621.12
3,546,303.71 5% 177,315.19
3,480,409.55 5% 174,020.48
3,460,441.63 5% 173,022.08
3,640,152.97 -
2,221,062.23 -
2,717,634.77 -
1,316,134.09 -
2,713,641.18 -
2,913,320.45 -
2,619,791.93 -
2,623,785.52 -
882,737.11 -
2,619,791.93
2,092,055.19
2,092,055.19
2,357,849.09
2,092,055.19
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4,526,040.48 15% 678,906.07
2,736,840.10 5% 136,842.01
2,857,063.05 5% 142,853.15
2,828,775.30 -
2,187,994.07 -
2,069,367.88 -
2,549,433.74 -
1,344,430.09 -
2,379,707.22 -
2,379,707.22 -
2,296,611.94 -
2,296,611.94 -
1,261,391.76 -
2,296,611.94 -
2,130,421.40
2,130,421.40
2,393,851.10
2,130,421.40
2,130,421.40
2,130,421.40
1,723,749.87
1,723,749.87 -
- -
- -
4,696,247.84 15% 704,437.18
3,859,152.30 5% 192,957.62
3,046,885.87 5% 152,344.29
2,071,535.63 -
2,187,647.18 -
2,387,141.08 -
2,387,141.08 -
2,387,141.08 -
1,262,713.12 -

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2,383,594.07 -
2,383,594.07 -
2,383,594.07 -
2,383,594.07 -
2,495,325.04
2,144,170.56
2,137,076.53
2,140,623.54
2,137,076.53
2,137,076.53
2,332,162.35
2,332,162.35
2,057,268.69
2,057,268.69
2,057,268.69
2,057,268.69
2,057,268.69
1,961,341.17
- -
- -
3,803,301.13 15% 570,495.17
2,954,586.79 5% 147,729.34
2,947,514.17 5% 147,375.71
2,947,514.17 5% 147,375.71
2,871,483.51 -
2,293,296.87 -
2,130,626.62
2,390,545.39
2,130,626.62
2,128,749.74 -
2,487,793.91
1,954,302.48
1,723,947.43
1,723,947.43

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1,723,947.43
1,723,947.43
-
- -
3,137,329.06 15% 470,599.36
2,834,556.25 5% 141,727.81
2,348,201.75 -
1,975,558.30 -
1,972,818.27 -
1,967,999.83 -
1,791,306.35 -
1,782,386.51 -
1,782,386.51 -
1,844,037.08 -
1,233,198.66 -
1,653,605.31 -
1,715,255.89
1,715,255.89
1,841,297.05 -
1,927,607.85
1,650,865.29
1,650,865.29
1,403,700.65
1,650,865.29
1,650,865.29
-
-
2,547,033.62 5% 127,351.68
1,897,568.28 -
1,900,392.05 -
1,900,392.05 -
1,900,392.05 -
1,856,623.73
1,856,623.73

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1,637,782.15
1,485,802.55
1,485,802.55
- -
-
3,277,070.35 15% 491,560.55
2,286,551.18 5% 114,327.56
1,855,890.86 -
1,841,297.05 -
1,656,345.34 -
1,844,037.08 -
1,841,297.05 -
1,650,865.29
1,801,566.69
1,589,214.72
1,531,839.30
575,071.08 -
1,262,102.50
-
- -
4,234,075.07 15% 635,111.26
3,087,577.93 5% 154,378.90
2,159,995.16 -
2,670,838.25 -
3,094,986.63 -
2,402,272.69 -
2,493,029.33 -
1,281,534.64 -
2,405,977.04 -
2,405,977.04 -
2,318,924.75 -
2,235,576.82
2,231,872.47
2,435,611.86

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2,148,524.53
2,064,790.68
1,821,412.31
1,821,412.31
- -
- -
3,910,313.25 15% 586,546.99
3,666,544.79 5% 183,327.24
2,086,390.21 -
2,454,381.08 -
2,747,368.04 5% 137,368.40
2,710,707.98 -
1,237,864.50 -
2,474,416.84 -
2,297,434.26 -
2,294,094.97 -
2,294,094.97 -
2,065,353.33
2,062,014.03
1,986,879.92
1,986,879.92
1,651,307.90
1,986,879.92
- -
- -
2,610,533.73 15% 391,580.06
2,583,072.30 5% 129,153.62
2,850,460.65 5% 142,523.03
2,968,178.78 -
1,974,561.12 -
2,260,188.26 -
2,184,512.32 -
2,181,148.94 -
2,184,512.32 -

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1,406,030.44
2,029,797.05
2,026,433.67
2,026,433.67
2,211,419.32
1,950,757.73
1,623,645.51
2,026,433.67
2,211,419.32
1,312,052.43 -
-
- -
6,298,882.25 15% 944,832.34
5,597,715.31 5% 279,885.77
5,842,822.06 5% 292,141.10
5,412,653.57 5% 270,632.68
5,400,306.96 5% 270,015.35
5,562,672.41 5% 278,133.62
5,317,372.09 5% 265,868.60
5,420,164.60 5% 271,008.23
5,343,070.22 5% 267,153.51
4,898,188.54 5% 244,909.43
4,774,370.29 5% 238,718.51
4,463,850.11 5% 223,192.51
4,507,069.70 5% 225,353.48
4,473,194.89 5% 223,659.74
4,846,126.64 5% 242,306.33
3,564,935.57 -
4,731,150.71 -
3,562,599.37 -
4,079,043.83 5% 203,952.19
4,184,172.54 5% 209,208.63
4,362,891.34 -
2,490,171.23 -

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2,490,171.23 -
2,490,171.23 -
2,320,797.20 -
3,914,342.19 -
4,061,522.38 -
3,431,609.34 -
3,431,609.34
3,379,044.98
-
- -
5,131,509.16 15% 769,726.37
4,691,349.64 15% 703,702.45
4,281,793.53 5% 214,089.68
4,119,542.62 5% 205,977.13
4,345,766.71 5% 217,288.34
3,994,382.55 5% 199,719.13
3,858,670.36 5% 192,933.52
4,159,084.19 5% 207,954.21
3,595,280.13 5% 179,764.01
3,899,553.75 5% 194,977.69
3,644,685.30 5% 182,234.26
3,839,025.68 5% 191,951.28
3,723,344.86 -
3,778,245.40 5% 188,912.27
-
-
2,233,580.62 15% 335,037.09
1,859,237.50 -
1,157,060.56
1,157,060.56
1,157,060.56
-
- -
3,911,818.17 5% 195,590.91

Page 169 of 248
3,884,373.24 5% 194,218.66
3,571,500.97 5% 178,575.05
3,695,918.01 5% 184,795.90
3,342,793.17 5% 167,139.66
3,511,122.11 5% 175,556.11
3,507,462.79 5% 175,373.14
3,170,804.91 5% 158,540.25
3,253,139.72 -
2,007,117.19 5% 100,355.86
2,751,812.22 -
2,744,493.57 -
2,216,257.34 -
2,576,164.63 -
2,572,505.31 -
2,490,170.50 -
2,486,511.18 -
3,701,407.00 5% 185,070.35
2,572,505.31 -
2,329,160.21
2,128,045.00
2,128,045.00
1,888,156.29
1,888,156.29
- -
- -
3,653,206.56 5% 182,660.33
3,529,141.72 5% 176,457.09
3,282,688.59 5% 164,134.43
3,515,729.30 5% 175,786.47
3,549,260.34 5% 177,463.02
3,049,647.88 5% 152,482.39
2,984,262.35 5% 149,213.12
2,898,758.21 5% 144,937.91
97,500.00 2,989,552.00 5% 149,477.60

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2,898,758.21 5% 144,937.91
2,974,203.04 5% 148,710.15
117,000.00 3,009,052.00 5% 150,452.60
2,091,765.03 -
48,750.00 1,547,308.60 -
2,275,080.91 -
146,250.00 2,345,886.07 -
1,972,605.66 -
1,498,558.60 -
2,524,887.14 -
2,275,080.91 -
2,278,434.01 -
97,500.00 2,543,589.20
146,250.00 2,345,886.07
2,202,989.18 -
1,323,705.18
1,828,837.29 -
2,127,544.34
2,127,544.34
97,500.00 2,454,731.95 -
2,278,434.01 -
2,278,434.01 -
2,199,636.07
97,500.00 2,221,691.24
2,367,291.26
2,120,838.13
2,120,838.13
1,407,395.11
2,367,291.26 -
2,206,342.28 -
2,202,989.18
2,202,989.18
48,750.00 2,498,192.30 -
146,250.00 2,267,088.13

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2,278,434.01 -
97,500.00 1,798,861.48
- -
- -
2,369,400.10 5% 118,470.00
10,119,447.21 5% 505,972.36
10,554,093.07 5% 527,704.65
9,835,255.69 5% 491,762.78
11,016,600.84 5% 550,830.04
9,812,966.15 5% 490,648.31
9,595,643.22 5% 479,782.16
10,091,585.30 -
9,857,545.22 -
9,879,834.75 -
9,071,839.24 -
7,283,104.35 -
2,523,315.13 -
7,043,491.89 -
- -
- -
3,796,457.11 15% 569,468.57
3,308,617.20 5% 165,430.86
2,635,623.53 -
1,421,781.79 -
- -
- -
2,772,936.52 5% 138,646.83
1,691,339.47
-
-
2,109,660.21 5% 105,483.01
- -
- -
3,231,504.06 15% 484,725.61

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2,982,821.14 5% 149,141.06
2,314,258.54 5% 115,712.93
2,329,654.61 5% 116,482.73
- -
- -
3,200,750.74 15% 480,112.61
1,936,107.93 -
- -
- -
3,770,358.32 15% 565,553.75
3,425,712.78 5% 171,285.64
2,707,701.25 5% 135,385.06
2,632,708.94 0% -
- -
- -
3,113,334.37 15% 467,000.16
2,877,150.38 5% 143,857.52
2,622,357.96 5% 131,117.90
2,039,770.79 5% 101,988.54
2,230,149.40 5% 111,507.47
2,446,293.54 -
2,423,390.85 -
- -
- -
3,327,881.91 5% 166,394.10
2,835,343.83 5% 141,767.19
2,332,695.00 5% 116,634.75
2,324,028.64 -
- -
- -
3,455,447.53 5% 172,772.38
2,824,238.04 5% 141,211.90
2,486,255.46 5% 124,312.77
2,558,790.53 -

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- -
3,805,163.65 5% 190,258.18
2,912,638.04 5% 145,631.90
2,435,446.13 -
2,265,777.89 -
1,924,409.52 5% 96,220.48
-
1,944,115.19
- -
- -
2,962,140.74 5% 148,107.04
2,830,079.18 5% 141,503.96
- -
- -
3,501,590.73 5% 175,079.54
3,017,295.67 5% 150,864.78
- -
- -
2,654,732.93 15% 398,209.94
2,022,537.20 5% 101,126.86
- -
- -
4,189,601.85 5% 209,480.09
3,311,761.11 -
1,415,736.68
2,332,082.70
- -
- -
3,208,510.20 15% 481,276.53
2,498,267.23 5% 124,913.36
1,862,794.72 -
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2,940,059.61 5% 147,002.98
1,881,226.95 -
- -
- -
1,972,170.29 -
1,348,447.71
1,466,216.06
- -
4,850,675.33 5% 242,533.77
3,462,730.52 5% 173,136.53
3,667,196.62 5% 183,359.83
3,626,460.75 -
716,284.98 -
3,291,143.22 -
2,309,671.50
2,554,971.82
2,630,971.87
2,153,851.60
2,153,851.60
- -
- -
3,320,887.34 -
3,330,232.12 -
974,713.82
- -
- -
3,241,249.27 5% 162,062.46
- -
- -
2,169,655.44 -
1,850,758.56 -
1,649,178.54 -
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1,381,303.59 -
1,326,004.38 -
- -
- -
3,520,403.35 5% 176,020.17
2,565,153.89 5% 128,257.69
3,035,709.73 5% 151,785.49
2,795,932.20 5% 139,796.61
2,783,190.64 5% 139,159.53
2,458,459.74 5% 122,922.99
2,514,846.08 5% 125,742.30
2,405,895.38 5% 120,294.77
2,414,953.18 -
1,930,193.02 -
2,158,776.22 -
1,872,956.28 -
1,948,442.01
-
- -
- -
4,163,053.36 5% 208,152.67
3,815,791.25 5% 190,789.56
3,493,509.00 5% 174,675.45
3,135,958.93 5% 156,797.95
3,081,058.38 5% 154,052.92
3,090,403.15 5% 154,520.16
2,883,537.57 5% 144,176.88
2,826,300.83 5% 141,315.04
2,885,873.76 5% 144,293.69
2,881,201.37 5% 144,060.07
2,828,637.02 5% 141,431.85
2,668,607.76 5% 133,430.39
3,107,924.61 -
2,369,518.76 -

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2,468,750.76 -
2,451,341.76 -
2,451,341.76 -
2,398,777.41 -
2,401,113.60 -
2,146,356.05 -
2,146,356.05 -
2,146,356.05 -
2,144,019.86
2,144,019.86
1,980,486.31
2,091,455.50
2,091,455.50
-
-
3,277,186.18 5% 163,859.31
2,258,493.34 -
2,205,928.99 -
2,148,692.24
1,027,880.03
- -
- -
2,732,704.78 15% 409,905.72
2,638,551.82 5% 131,927.59
2,416,214.69 5% 120,810.73
2,534,189.49 5% 126,709.47
2,238,118.12 5% 111,905.91
2,293,702.40 5% 114,685.12
1,838,818.79 5% 91,940.94
1,871,715.61 5% 93,585.78
1,951,121.72 -
1,746,934.57 -
1,849,028.14 -
1,864,909.37 -

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1,647,109.73 -
1,480,356.89 -
1,482,625.63 -
1,469,013.16 -
1,471,281.90 -
1,366,919.58 -
1,480,356.89 -
1,378,263.31 -
1,284,761.44 -
1,292,050.95 -
1,334,022.76 -
1,331,754.01 -
1,331,754.01 -
1,280,707.22 -
1,278,438.48 -
1,280,707.22 -
1,280,707.22 -
1,354,441.47 -
1,222,722.91 -
1,229,660.43 -
1,178,613.65
1,455,085.39
1,298,857.19
1,329,485.27 -
627,425.16
627,425.16
627,425.16
- -
- -
1,967,002.95 5% 98,350.15
1,817,265.70 -
1,678,872.18 -
1,761,681.42 -
1,347,635.24 -

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1,691,350.28 -
1,695,887.78 -
1,749,203.31 -
1,437,250.71 -
1,261,422.88 -
1,386,203.92 -
1,390,741.41 -
1,210,376.09 -
1,210,376.09 -
1,335,157.13 -
1,088,998.17
1,088,998.17
1,088,998.17
1,088,998.17
610,313.57
610,313.57
-
- -
2,604,520.62 5% 130,226.03
2,704,345.46 15% 405,651.82
2,217,699.40 5% 110,884.97
1,964,734.20 5% 98,236.71
2,067,962.15 -
1,761,681.42 -
1,812,728.20 -
1,699,290.90 -
1,546,150.53 -
1,534,806.80 -
1,279,572.85 -
1,446,325.70 -
1,397,547.65 -
1,397,547.65 -
1,914,821.78 -
1,590,391.08 -

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1,763,950.16 -
1,499,641.23 -
661,648.35
661,648.35
661,648.35
- -
- -
2,310,495.40 15% 346,574.31
2,534,769.98 5% 126,738.50
2,345,538.31 5% 117,276.92
1,999,781.66 5% 99,989.08
1,955,393.99 5% 97,769.70
2,256,762.95 5% 112,838.15
2,111,918.95 5% 105,595.95
2,149,298.05 5% 107,464.90
2,017,303.12 5% 100,865.16
1,901,661.54 5% 95,083.08
1,728,783.21 -
1,798,869.02 -
947,244.77 -
1,691,404.12 -
1,748,640.86 -
1,743,968.47 -
1,781,347.57 -
1,693,740.31 -
1,691,404.12 -
1,868,954.83 -
1,708,925.57 -
1,623,654.51 -
1,621,318.31 -
1,623,654.51 -
1,749,808.96 -
1,662,201.70 -
1,662,201.70 -

Page 180 of 248
1,662,201.70 -
1,524,366.28 -
1,588,611.60 -
1,678,555.05 -
1,680,891.25 -
1,444,935.70 -
1,444,935.70 -
1,369,009.41 -
1,404,052.31 -
1,369,009.41 -
1,444,935.70 -
1,263,880.70 -
1,298,923.60 -
1,263,880.70 -
1,263,880.70
1,263,880.70
1,620,150.21
1,518,525.80
1,555,904.89
1,501,004.34
1,138,642.96
1,138,642.96
1,096,110.00
1,096,110.00
- -
- -
2,166,652.61 5% 108,332.63
2,052,080.93 5% 102,604.05
1,852,431.26 5% 92,621.56
1,616,385.55 -
1,625,556.64 -
1,625,556.64 -
1,689,081.54 -
1,880,790.59 -

Page 181 of 248
1,636,900.38 -
1,652,781.60 -
1,374,860.19 -
1,335,157.13 -
1,335,157.13 -
1,499,641.23 -
1,332,888.39
1,550,688.02 -
-
- -
1,890,483.03 5% 94,524.15
2,529,652.00 5% 126,482.60
1,267,094.75
-
- -
1,824,774.25 2,893,920.89 5% 144,696.04
984,932.00 1,900,938.27 -
1,179,535.50 2,044,494.98 -
1,499,241.25 2,389,724.13 -
1,117,977.25 2,012,997.62 -
885,638.00 1,700,685.07 -
907,487.74 1,721,400.44 -
925,359.50 1,448,305.50 -
- -
- -
1,707,231.51 -
1,480,356.89 -
1,364,650.83 -
1,313,604.04 -
-
- -
1,762,815.79 -
2,053,215.30 5% 102,660.77
2,087,246.49 5% 104,362.32

Page 182 of 248
1,698,156.52 -
1,695,887.78 -
1,700,425.27 -
1,749,203.31 -
1,751,472.06 -
1,484,894.38 -
1,647,109.73 -
1,623,287.90 -
1,334,022.76 -
1,331,754.01 -
1,231,929.18 -
1,229,660.43 -
1,523,463.07 -
1,229,660.43 -
1,229,660.43 -
1,227,391.69
-
-
1,193,360.50 -
1,130,969.98 -
-
-
2,277,016.00 2,277,016.00 15% 341,552.40
2,436,232.50 3,946,083.09 15% 591,912.46
3,045,791.76 15% 456,868.76
2,808,707.78 15% 421,306.17
2,896,054.51 15% 434,408.18
28,565,030.00 1,005,480.00 31,155,229.21 15% 4,673,284.38
4,077,593.00 2,513,700.00 8,174,877.84 15% 1,226,231.68
6,380,406.50 1,142,100.00 9,103,822.59 15% 1,365,573.39
22,973,600.00 4,406,400.00 28,835,967.87 15% 4,325,395.18
5,992,350.00 7,476,677.19 15% 1,121,501.58
76,567,302.50 78,073,182.78 15% 11,710,977.42
11,568,184.88 949,680.00 13,954,548.40 15% 2,093,182.26

Page 183 of 248
13,204,295.00 1,752,030.00 16,310,766.47 15% 2,446,614.97
1,390,935.00 8,574,660.00 11,440,847.21 15% 1,716,127.08
39,975.00 1,008,180.00 2,382,744.95 15% 357,411.74
2,602,251.88 15% 390,337.78
40,794,854.75 42,149,863.41 15% 6,322,479.51
13,224,885.38 1,007,280.00 15,711,387.90 15% 2,356,708.18
3,532,847.50 4,817,525.03 15% 722,628.75
23,886,271.50 826,389.00 26,042,145.77 15% 3,906,321.87
14,848,736.50 283,500.00 16,458,318.65 5% 822,915.93
2,012,497.50 3,264,845.40 15% 489,726.81
2,853,825.00 1,849,500.00 5,755,456.05 5% 287,772.80
1,019,801.41 5% 50,990.07
13,974,857.00 2,466,450.00 17,842,824.96 15% 2,676,423.74
6,896,360.25 7,861,711.75 5% 393,085.59
7,919,411.50 8,941,481.66 5% 447,074.08
12,175,585.50 13,169,863.52 5% 658,493.18
9,075,248.00 1,077,300.00 11,099,182.35 5% 554,959.12
14,472,783.00 2,873,934.00 18,313,202.88 5% 915,660.14
408,525.00 1,501,493.48 15% 225,224.02
34,685,790.75 35,550,183.05 5% 1,777,509.15
49,567,420.50 50,381,900.38 5% 2,519,095.02
1,734,135.00 273,780.00 3,461,614.12 15% 519,242.12
3,424,427.50 666,900.00 5,237,611.51 5% 261,880.58
962,650.00 873,450.00 2,716,373.52 5% 135,818.68
9,266,364.25 2,177,280.00 12,357,948.96 5% 617,897.45
74,537,027.50 75,424,674.45 5% 3,771,233.72
1,998,847.50 2,856,433.56
34,092,194.50 1,924,290.00 36,930,789.21 5% 1,846,539.46
13,315,065.06 660,903.30 15,378,620.69 15% 2,306,793.10
121,777,337.50 1,541,052.00 124,260,486.35 5% 6,213,024.32
39,164,196.50 548,100.00 40,578,957.54 5% 2,028,947.88
24,462,022.00 1,282,500.00 26,840,893.60 5% 1,342,044.68
21,804,100.50 22,720,673.96 5% 1,136,033.70
11,236,394.00 3,679,884.00 15,782,939.04 5% 789,146.95

Page 184 of 248
4,036,500.00 2,400,516.00 7,234,480.29 5% 361,724.01
74,668,048.00 874,584.00 76,379,232.16
2,351,797.50 3,178,037.84
3,310,222.50 1,629,504.00 5,890,331.15 5% 294,516.56
19,466,245.00 769,500.00 21,228,888.64 5% 1,061,444.43
9,336,080.00 561,600.00 10,734,280.16
49,545,905.00 569,019.60 50,951,524.76
25,474,364.50 3,218,346.00 29,529,310.66
32,043,667.50 418,608.00 33,298,875.66
5,045,736.80 5,877,617.01
2,308,897.50 3,139,825.79
18,961,475.00 19,789,567.36
3,720,860.00 4,551,788.29
3,539,347.50 4,370,275.79
3,001,147.50 3,832,075.79
3,404,797.50 4,235,725.79
2,553,297.50 3,379,537.84
873,600.00 1,710,200.16
11,583,149.50 1,402,650.00 14,132,083.51 5% 706,604.18
8,876,710.05 440,602.20 10,388,160.45 5% 519,408.02
3,794,115.00 2,638,083.60 7,268,798.76 -
3,080,025.00 135,000.00 4,289,843.51 15% 643,476.53
35,900,292.19 2,377,557.90 39,114,450.25
87,412,315.25 1,305,648.00 89,554,563.41
1,523,047.50 1,527,735.45
2,013,797.50 3,052,316.07 15% 457,847.41
2,273,797.50 3,079,202.40
2,988,797.50 3,794,202.40
30,460,293.50 1,171,584.00 32,442,954.26
26,472,316.00 102,600.00 27,385,992.76
2,271.97
2,271.97
2,271.97
2,985,092.10 2,985,092.10 15% 447,763.82

Page 185 of 248
182,910,000.00 182,910,000.00 5% 9,145,500.00
-
-
3,500,000.00 0% -
1,650,000.00 0% -
4,620,778.20 4,620,778.20 15% 693,116.73
- 5% -
- 5% -
1,632,824,502.91 72,985,995.90 15,086,473.69 3,816,380,950.08 184,674,346.77
1,632,824,502.91 72,985,995.90 15,086,473.69

- - -
1,632,824,503
-
DIREKTUR RSUD IBNU SI
dr. ENDANG PUSPITOW

- NIP. 19601229 198

Page 186 of 248
PAJAK TOTAL POTONGAN POTONGAN
THL SETELAH INFAQ TOTAL VAKSIN, KOP
PAJAK D.WANITA, DLL
97,319,884.79 27,500.00 97,292,384.79

32,439,961.60 27,500.00 32,412,461.60
32,439,961.60 27,500.00 32,412,461.60 9,559,250.00
- -
- -
10,551,476.43 27,500.00 10,523,976.43 777,750.00
8,164,264.57 17,500.00 8,146,764.57
8,164,264.57 17,500.00 8,146,764.57 279,350.00
8,164,264.57 17,500.00 8,146,764.57 1,019,200.00
2,342,820.75 17,500.00 2,325,320.75 330,000.00
2,031,378.62 17,500.00 2,013,878.62 269,550.00
1,740,411.92 17,500.00 1,722,911.92 366,100.00
1,855,720.95 17,500.00 1,838,220.95
1,668,662.82 12,500.00 1,656,162.82 284,200.00
1,866,043.74 12,500.00 1,853,543.74
1,664,125.33 12,500.00 1,651,625.33 1,133,400.00
2,008,974.75 12,500.00 1,996,474.75
1,557,494.26 12,500.00 1,544,994.26 526,000.00
1,535,941.17 12,500.00 1,523,441.17 186,700.00
- 1,586,987.96 5,000.00 1,581,987.96 566,700.00
- 1,584,719.21 5,000.00 1,579,719.21
- 1,638,034.75 5,000.00 1,633,034.75 480,200.00
- 1,351,038.36 5,000.00 1,346,038.36 147,000.00
- 1,482,625.63 5,000.00 1,477,625.63 182,000.00
- 1,586,987.96 5,000.00 1,581,987.96 622,350.00
- 1,484,894.38 5,000.00 1,479,894.38
- 1,028,876.40 5,000.00 1,023,876.40 637,000.00
- 1,433,847.59 5,000.00 1,428,847.59
- 1,142,313.71 5,000.00 1,137,313.71 284,200.00
- 1,142,313.71 5,000.00 1,137,313.71 279,350.00
- 8,063.91 - 8,063.91

Page 187 of 248
PAJAK D.WANITA, DLL
- 1,635,766.00 5,000.00 1,630,766.00 298,300.00
1,378,263.31 5,000.00 1,373,263.31
- - -
- - -
- 10,551,476.43 27,500.00 10,523,976.43 100,000.00
- 7,304,868.30 27,500.00 7,277,368.30
- 7,304,868.30 27,500.00 7,277,368.30 100,000.00
- 2,146,687.64 17,500.00 2,129,187.64 300,000.00
- 2,249,064.82 17,500.00 2,231,564.82 2,253,300.00
- 1,705,926.98 17,500.00 1,688,426.98 200,000.00
- 1,883,739.96 17,500.00 1,866,239.96 200,000.00
- 1,853,565.64 17,500.00 1,836,065.64 100,000.00
- 1,792,139.33 17,500.00 1,774,639.33 100,000.00
- 1,614,212.91 12,500.00 1,601,712.91 648,800.00
- 1,733,322.09 12,500.00 1,720,822.09 782,500.00
- 1,812,728.20 12,500.00 1,800,228.20 1,000,000.00
- 1,846,759.40 12,500.00 1,834,259.40 300,000.00
- 1,795,712.61 12,500.00 1,783,212.61 100,000.00
- 1,897,806.19 12,500.00 1,885,306.19 100,000.00
- 1,661,856.58 12,500.00 1,649,356.58 100,000.00
- 1,659,587.84 12,500.00 1,647,087.84 100,000.00
- 1,693,619.03 12,500.00 1,681,119.03 100,000.00
- 1,659,587.84 12,500.00 1,647,087.84 666,700.00
- 1,586,987.96 5,000.00 1,581,987.96 666,700.00
- 1,635,766.00 5,000.00 1,630,766.00 100,000.00
- 1,584,719.21 5,000.00 1,579,719.21 100,000.00
- 1,454,266.31 5,000.00 1,449,266.31 100,000.00
- 1,695,887.78 12,500.00 1,683,387.78 100,000.00
- 1,318,141.54 5,000.00 1,313,141.54 986,700.00
- 1,589,256.71 5,000.00 1,584,256.71 200,000.00
- 1,465,610.04 5,000.00 1,460,610.04 100,000.00
- - - - 666,600.00
- 1,465,610.04 5,000.00 1,460,610.04 875,000.00
- 1,518,925.57 5,000.00 1,513,925.57 620,900.00

Page 188 of 248
PAJAK D.WANITA, DLL
- - -
- - -
- 10,446,968.09 - 10,446,968.09
- 8,200,204.09 17,500.00 8,182,704.09
- 8,164,264.57 17,500.00 8,146,764.57
- 1,971,029.97 17,500.00 1,953,529.97 1,150,000.00
- 1,600,316.84 17,500.00 1,582,816.84
- 1,948,852.98 12,500.00 1,936,352.98 330,000.00
- 1,763,950.16 12,500.00 1,751,450.16
- 1,849,028.14 12,500.00 1,836,528.14 555,350.00
- 1,879,429.34 17,500.00 1,861,929.34
- 1,763,950.16 12,500.00 1,751,450.16
- 1,712,903.37 12,500.00 1,700,403.37 1,255,000.00
- 1,693,619.03 12,500.00 1,681,119.03 651,000.00
- 1,610,809.79 12,500.00 1,598,309.79
- 1,480,356.89 12,500.00 1,467,856.89 330,000.00
- - - -
- 1,537,427.43 12,500.00 1,524,927.43
- 1,546,150.53 12,500.00 1,533,650.53
- 1,529,134.93 12,500.00 1,516,634.93
- 1,817,265.70 12,500.00 1,804,765.70 600,000.00
- 1,817,265.70 12,500.00 1,804,765.70 1,133,400.00
- 1,868,312.49 12,500.00 1,855,812.49 566,700.00
- 1,916,069.59 17,500.00 1,898,569.59 566,700.00
- 1,369,188.33 5,000.00 1,364,188.33
- 1,369,188.33 5,000.00 1,364,188.33
- 1,351,038.36 5,000.00 1,346,038.36 379,750.00
- 1,331,754.01 5,000.00 1,326,754.01 511,939.00
- 1,329,485.27 5,000.00 1,324,485.27 825,100.00
- 1,318,141.54 5,000.00 1,313,141.54
- 1,337,425.88 5,000.00 1,332,425.88
- 1,152,788.58 5,000.00 1,147,788.58
- 1,284,110.34 5,000.00 1,279,110.34 343,000.00
- 1,142,313.71 5,000.00 1,137,313.71 705,600.00

Page 189 of 248
PAJAK D.WANITA, DLL
- 1,267,094.75 5,000.00 1,262,094.75
- 2,368,684.46 2,368,684.46
- 2,096,037.89 17,500.00 2,078,537.89 100,000.00
- 1,897,806.19 12,500.00 1,885,306.19 1,300,000.00
- 1,932,234.41 17,500.00 1,914,734.41 1,133,300.00
- 1,846,759.40 12,500.00 1,834,259.40 1,233,350.00
- 1,744,665.82 12,500.00 1,732,165.82 1,530,000.00
- 1,846,759.40 12,500.00 1,834,259.40 1,000,000.00
- 1,591,525.45 12,500.00 1,579,025.45 1,372,900.00
- 1,593,794.20 12,500.00 1,581,294.20 1,044,500.00
- 1,227,391.69 5,000.00 1,222,391.69
- 1,429,310.10 5,000.00 1,424,310.10
- 1,352,172.73 5,000.00 1,347,172.73 100,000.00
- 1,227,391.69 5,000.00 1,222,391.69
- 1,295,454.07 5,000.00 1,290,454.07 392,000.00
- 1,944,088.61 17,500.00 1,926,588.61 786,700.00
- 1,800,250.10 12,500.00 1,787,750.10 840,000.00
- 1,518,925.57 5,000.00 1,513,925.57
- 1,516,656.83 5,000.00 1,511,656.83
- 1,227,391.69 5,000.00 1,222,391.69
- 1,301,125.94 5,000.00 1,296,125.94
- 1,176,344.90 5,000.00 1,171,344.90
- 1,174,076.15 5,000.00 1,169,076.15
- 1,174,076.15 5,000.00 1,169,076.15
- 1,088,998.17 5,000.00 1,083,998.17
- - -
- - -
- 11,792,826.60 17,500.00 11,775,326.60
- 8,272,327.07 17,500.00 8,254,827.07 377,350.00
- 8,164,264.57 17,500.00 8,146,764.57 2,912,500.00
- 1,999,048.99 17,500.00 1,981,548.99
- 1,814,996.95 12,500.00 1,802,496.95 330,000.00
- 1,586,987.96 5,000.00 1,581,987.96

Page 190 of 248
PAJAK D.WANITA, DLL
- 1,433,847.59 5,000.00 1,428,847.59
- 1,431,578.85 5,000.00 1,426,578.85
- 1,429,310.10 5,000.00 1,424,310.10
- - -
- - -
- 10,551,476.43 27,500.00 10,523,976.43 4,625,000.00
- 8,164,264.57 17,500.00 8,146,764.57
- 8,164,264.57 17,500.00 8,146,764.57
- 1,661,856.58 12,500.00 1,649,356.58
- 1,610,809.79 12,500.00 1,598,309.79
- 1,638,034.75 5,000.00 1,633,034.75
- - -
- - -
- 10,551,476.43 27,500.00 10,523,976.43
- 8,164,264.57 17,500.00 8,146,764.57
- 8,164,264.57 17,500.00 8,146,764.57 3,875,400.00
- 1,863,774.99 12,500.00 1,851,274.99 682,500.00
- 1,642,572.24 5,000.00 1,637,572.24
- 1,391,875.79 5,000.00 1,386,875.79
- -
- -
- 2,252,297.78 17,500.00 2,234,797.78 188,900.00
2,020,602.07 17,500.00 2,003,102.07
- 1,429,310.10 5,000.00 1,424,310.10
1,213,779.21 5,000.00 1,208,779.21
- -
- - -
- 2,807,271.72 17,500.00 2,789,771.72
- 2,487,989.75 17,500.00 2,470,489.75 264,600.00
- 2,173,527.12 17,500.00 2,156,027.12 550,000.00
- 2,171,244.27 12,500.00 2,158,744.27 1,802,800.00
- 1,926,913.21 12,500.00 1,914,413.21
- 1,707,064.71 5,000.00 1,702,064.71 1,316,666.00
- 1,644,920.45 5,000.00 1,639,920.45 550,000.00

Page 191 of 248
PAJAK D.WANITA, DLL
- 1,704,528.21 5,000.00 1,699,528.21
- 1,849,108.73 5,000.00 1,844,108.73
- 1,590,385.70 5,000.00 1,585,385.70 550,000.00
- 1,647,456.95 5,000.00 1,642,456.95 550,000.00
- 1,714,674.21 5,000.00 1,709,674.21
- 1,528,241.44 5,000.00 1,523,241.44
- 1,585,312.70 5,000.00 1,580,312.70
1,471,170.18 5,000.00 1,466,170.18
1,144,057.96 5,000.00 1,139,057.96
1,144,057.96 5,000.00 1,139,057.96
- - -
- - -
- 4,148,348.43 17,500.00 4,130,848.43
- 4,155,697.14 17,500.00 4,138,197.14
- 3,321,618.23 17,500.00 3,304,118.23
- 3,322,391.77 12,500.00 3,309,891.77
- 2,254,118.20 12,500.00 2,241,618.20
- 1,617,853.23 7,500.00 1,610,353.23
- 3,159,946.54 17,500.00 3,142,446.54
- 3,148,923.47 17,500.00 3,131,423.47
- 2,256,837.28 12,500.00 2,244,337.28
2,602,991.46 12,500.00 2,590,491.46
- 2,610,726.95 5,000.00 2,605,726.95
- 2,610,726.95 5,000.00 2,605,726.95
- 2,523,702.72 5,000.00 2,518,702.72
- 2,606,859.20 5,000.00 2,601,859.20
- 2,879,535.13 12,500.00 2,867,035.13
- 2,788,643.15 12,500.00 2,776,143.15 671,000.00
- 2,519,834.97 5,000.00 2,514,834.97 1,943,800.00
- 2,519,834.97 5,000.00 2,514,834.97
- 1,463,110.38 5,000.00 1,458,110.38
- 2,432,810.74 5,000.00 2,427,810.74
- 2,515,967.23 5,000.00 2,510,967.23 550,000.00
- 2,428,943.00 5,000.00 2,423,943.00 550,000.00

Page 192 of 248
PAJAK D.WANITA, DLL
- 2,428,943.00 5,000.00 2,423,943.00 550,000.00
- 2,341,918.77 5,000.00 2,336,918.77
- 2,330,315.53 5,000.00 2,325,315.53
- 2,330,315.53 5,000.00 2,325,315.53
- 2,338,051.02 5,000.00 2,333,051.02 550,000.00
- 2,338,051.02 5,000.00 2,333,051.02
- - -
- - -
- 4,302,588.92 27,500.00 4,275,088.92
- 3,849,416.83 27,500.00 3,821,916.83 1,150,000.00
- 4,023,437.31 17,500.00 4,005,937.31 550,000.00
- 3,465,733.13 17,500.00 3,448,233.13 550,000.00
- 3,454,351.41 17,500.00 3,436,851.41 550,000.00
- 3,368,988.53 17,500.00 3,351,488.53 550,000.00
- 3,384,164.15 17,500.00 3,366,664.15 600,000.00
- 3,298,801.27 17,500.00 3,281,301.27 1,483,333.00
- 3,368,988.53 17,500.00 3,351,488.53
- 3,306,389.08 17,500.00 3,288,889.08 550,000.00
- 3,287,419.55 17,500.00 3,269,919.55
- 3,640,152.97 12,500.00 3,627,652.97
- 2,221,062.23 12,500.00 2,208,562.23 944,400.00
- 2,717,634.77 5,000.00 2,712,634.77 550,000.00
- 1,316,134.09 5,000.00 1,311,134.09 108,500.00
- 2,713,641.18 5,000.00 2,708,641.18 550,000.00
- 2,913,320.45 5,000.00 2,908,320.45
- 2,619,791.93 5,000.00 2,614,791.93 550,000.00
- 2,623,785.52 5,000.00 2,618,785.52
- 882,737.11 5,000.00 877,737.11 550,000.00
- 2,619,791.93 5,000.00 2,614,791.93 550,000.00
2,092,055.19 5,000.00 2,087,055.19
2,092,055.19 5,000.00 2,087,055.19
2,357,849.09 5,000.00 2,352,849.09
2,092,055.19 5,000.00 2,087,055.19
- - -

Page 193 of 248
PAJAK D.WANITA, DLL
- - -
- 3,847,134.40 27,500.00 3,819,634.40 1,350,000.00
- 2,599,998.10 17,500.00 2,582,498.10 720,000.00
- 2,714,209.90 17,500.00 2,696,709.90
- 2,828,775.30 12,500.00 2,816,275.30 1,020,000.00
- 2,187,994.07 12,500.00 2,175,494.07 450,000.00
- 2,069,367.88 12,500.00 2,056,867.88 560,000.00
- 2,549,433.74 12,500.00 2,536,933.74 720,000.00
- 1,344,430.09 5,000.00 1,339,430.09 560,000.00
- 2,379,707.22 5,000.00 2,374,707.22 120,000.00
- 2,379,707.22 5,000.00 2,374,707.22 120,000.00
- 2,296,611.94 5,000.00 2,291,611.94 720,000.00
- 2,296,611.94 5,000.00 2,291,611.94 670,000.00
- 1,261,391.76 5,000.00 1,256,391.76 100,000.00
- 2,296,611.94 5,000.00 2,291,611.94 720,000.00
- 2,130,421.40 5,000.00 2,125,421.40 670,000.00
- 2,130,421.40 5,000.00 2,125,421.40 120,000.00
- 2,393,851.10 5,000.00 2,388,851.10 120,000.00
- 2,130,421.40 5,000.00 2,125,421.40 120,000.00
- 2,130,421.40 5,000.00 2,125,421.40 120,000.00
- 2,130,421.40 5,000.00 2,125,421.40 120,000.00
1,723,749.87 5,000.00 1,718,749.87
- 1,723,749.87 5,000.00 1,718,749.87
- - -
- - -
- 3,991,810.66 27,500.00 3,964,310.66 550,000.00
- 3,666,194.69 17,500.00 3,648,694.69
- 2,894,541.58 17,500.00 2,877,041.58
- 2,071,535.63 12,500.00 2,059,035.63
- 2,187,647.18 12,500.00 2,175,147.18
- 2,387,141.08 5,000.00 2,382,141.08 600,000.00
- 2,387,141.08 5,000.00 2,382,141.08
- 2,387,141.08 5,000.00 2,382,141.08
- 1,262,713.12 5,000.00 1,257,713.12

Page 194 of 248
PAJAK D.WANITA, DLL
- 2,383,594.07 5,000.00 2,378,594.07 930,000.00
- 2,383,594.07 5,000.00 2,378,594.07 730,000.00
- 2,383,594.07 5,000.00 2,378,594.07
- 2,383,594.07 5,000.00 2,378,594.07 1,100,000.00
- 2,495,325.04 5,000.00 2,490,325.04
- 2,144,170.56 5,000.00 2,139,170.56 725,200.00
- 2,137,076.53 5,000.00 2,132,076.53
- 2,140,623.54 5,000.00 2,135,623.54
- 2,137,076.53 5,000.00 2,132,076.53
- 2,137,076.53 5,000.00 2,132,076.53
- 2,332,162.35 5,000.00 2,327,162.35
- 2,332,162.35 5,000.00 2,327,162.35
- 2,057,268.69 5,000.00 2,052,268.69
- 2,057,268.69 5,000.00 2,052,268.69
- 2,057,268.69 5,000.00 2,052,268.69
- 2,057,268.69 5,000.00 2,052,268.69
- 2,057,268.69 5,000.00 2,052,268.69
1,961,341.17 5,000.00 1,956,341.17
- - -
- - -
- 3,232,805.96 27,500.00 3,205,305.96
- 2,806,857.45 17,500.00 2,789,357.45 775,000.00
- 2,800,138.46 17,500.00 2,782,638.46 900,000.00
- 2,800,138.46 17,500.00 2,782,638.46 1,200,000.00
- 2,871,483.51 2,871,483.51
- 2,293,296.87 5,000.00 2,288,296.87 1,150,000.00
- 2,130,626.62 5,000.00 2,125,626.62
- 2,390,545.39 5,000.00 2,385,545.39 550,000.00
- 2,130,626.62 5,000.00 2,125,626.62
- 2,128,749.74 12,500.00 2,116,249.74 430,000.00
- 2,487,793.91 5,000.00 2,482,793.91
1,954,302.48 5,000.00 1,949,302.48
1,723,947.43 5,000.00 1,718,947.43
1,723,947.43 5,000.00 1,718,947.43

Page 195 of 248
PAJAK D.WANITA, DLL
1,723,947.43 5,000.00 1,718,947.43
1,723,947.43 5,000.00 1,718,947.43
- -
- - -
- 2,666,729.70 27,500.00 2,639,229.70 550,000.00
- 2,692,828.44 17,500.00 2,675,328.44
- 2,348,201.75 12,500.00 2,335,701.75 1,862,300.00
- 1,975,558.30 12,500.00 1,963,058.30
- 1,972,818.27 12,500.00 1,960,318.27 1,001,950.00
- 1,967,999.83 12,500.00 1,955,499.83
- 1,791,306.35 12,500.00 1,778,806.35
- 1,782,386.51 5,000.00 1,777,386.51
- 1,782,386.51 5,000.00 1,777,386.51
- 1,844,037.08 5,000.00 1,839,037.08
- 1,233,198.66 5,000.00 1,228,198.66 600,000.00
- 1,653,605.31 5,000.00 1,648,605.31
- 1,715,255.89 5,000.00 1,710,255.89 227,350.00
- 1,715,255.89 5,000.00 1,710,255.89 550,000.00
- 1,841,297.05 5,000.00 1,836,297.05
- 1,927,607.85 5,000.00 1,922,607.85
- 1,650,865.29 5,000.00 1,645,865.29
- 1,650,865.29 5,000.00 1,645,865.29
- 1,403,700.65 - 1,403,700.65
- 1,650,865.29 5,000.00 1,645,865.29
- 1,650,865.29 5,000.00 1,645,865.29
- -
- -
- 2,419,681.94 17,500.00 2,402,181.94
- 1,897,568.28 5,000.00 1,892,568.28
- 1,900,392.05 5,000.00 1,895,392.05
- 1,900,392.05 5,000.00 1,895,392.05 1,016,666.00
- 1,900,392.05 5,000.00 1,895,392.05 977,800.00
- 1,856,623.73 5,000.00 1,851,623.73
- 1,856,623.73 5,000.00 1,851,623.73

Page 196 of 248
PAJAK D.WANITA, DLL
- 1,637,782.15 5,000.00 1,632,782.15
1,485,802.55 5,000.00 1,480,802.55
1,485,802.55 5,000.00 1,480,802.55
- - -
- -
- 2,785,509.80 27,500.00 2,758,009.80 600,000.00
- 2,172,223.62 17,500.00 2,154,723.62 1,655,600.00
- 1,855,890.86 12,500.00 1,843,390.86 738,500.00
- 1,841,297.05 5,000.00 1,836,297.05 600,000.00
- 1,656,345.34 5,000.00 1,651,345.34
- 1,844,037.08 5,000.00 1,839,037.08 1,166,600.00
- 1,841,297.05 5,000.00 1,836,297.05 550,000.00
- 1,650,865.29 5,000.00 1,645,865.29
- 1,801,566.69 5,000.00 1,796,566.69
- 1,589,214.72 5,000.00 1,584,214.72
- 1,531,839.30 - 1,531,839.30
- 575,071.08 - 575,071.08 566,700.00
1,262,102.50 5,000.00 1,257,102.50
- -
- - -
- 3,598,963.81 27,500.00 3,571,463.81 550,000.00
- 2,933,199.03 17,500.00 2,915,699.03
- 2,159,995.16 2,159,995.16 1,105,000.00
- 2,670,838.25 12,500.00 2,658,338.25
- 3,094,986.63 12,500.00 3,082,486.63
- 2,402,272.69 5,000.00 2,397,272.69
- 2,493,029.33 5,000.00 2,488,029.33 600,000.00
- 1,281,534.64 5,000.00 1,276,534.64
- 2,405,977.04 5,000.00 2,400,977.04
- 2,405,977.04 5,000.00 2,400,977.04
- 2,318,924.75 5,000.00 2,313,924.75 1,150,000.00
- 2,235,576.82 5,000.00 2,230,576.82
- 2,231,872.47 5,000.00 2,226,872.47
- 2,435,611.86 5,000.00 2,430,611.86

Page 197 of 248
PAJAK D.WANITA, DLL
- 2,148,524.53 5,000.00 2,143,524.53
2,064,790.68 5,000.00 2,059,790.68
1,821,412.31 5,000.00 1,816,412.31
1,821,412.31 5,000.00 1,816,412.31
- - -
- - -
- 3,323,766.27 27,500.00 3,296,266.27 1,400,000.00
- 3,483,217.55 17,500.00 3,465,717.55
- 2,086,390.21 12,500.00 2,073,890.21 330,000.00
- 2,454,381.08 12,500.00 2,441,881.08
- 2,609,999.64 17,500.00 2,592,499.64 2,862,500.00
- 2,710,707.98 12,500.00 2,698,207.98 1,450,000.00
- 1,237,864.50 5,000.00 1,232,864.50 516,700.00
- 2,474,416.84 5,000.00 2,469,416.84
- 2,297,434.26 5,000.00 2,292,434.26
- 2,294,094.97 5,000.00 2,289,094.97 1,650,000.00
- 2,294,094.97 5,000.00 2,289,094.97
- 2,065,353.33 5,000.00 2,060,353.33
- 2,062,014.03 5,000.00 2,057,014.03
- 1,986,879.92 5,000.00 1,981,879.92
- 1,986,879.92 5,000.00 1,981,879.92
1,651,307.90 5,000.00 1,646,307.90
- 1,986,879.92 5,000.00 1,981,879.92
- - -
- - -
- 2,218,953.67 - 2,218,953.67 900,000.00
- 2,453,918.69 - 2,453,918.69
- 2,707,937.61 17,500.00 2,690,437.61
- 2,968,178.78 12,500.00 2,955,678.78 880,000.00
- 1,974,561.12 12,500.00 1,962,061.12 1,919,100.00
- 2,260,188.26 5,000.00 2,255,188.26 1,145,600.00
- 2,184,512.32 5,000.00 2,179,512.32
- 2,181,148.94 5,000.00 2,176,148.94 550,000.00
- 2,184,512.32 5,000.00 2,179,512.32

Page 198 of 248
PAJAK D.WANITA, DLL
- 1,406,030.44 5,000.00 1,401,030.44 330,000.00
- 2,029,797.05 5,000.00 2,024,797.05
- 2,026,433.67 5,000.00 2,021,433.67
- 2,026,433.67 5,000.00 2,021,433.67
- 2,211,419.32 5,000.00 2,206,419.32
- 1,950,757.73 5,000.00 1,945,757.73
1,623,645.51 5,000.00 1,618,645.51
- 2,026,433.67 5,000.00 2,021,433.67
- 2,211,419.32 5,000.00 2,206,419.32
- 1,312,052.43 5,000.00 1,307,052.43
- -
- - -
- 5,354,049.91 27,500.00 5,326,549.91 1,277,350.00
- 5,317,829.54 17,500.00 5,300,329.54
- 5,550,680.96 17,500.00 5,533,180.96 2,450,600.00
- 5,142,020.89 17,500.00 5,124,520.89
- 5,130,291.61 17,500.00 5,112,791.61
- 5,284,538.79 17,500.00 5,267,038.79
- 5,051,503.48 17,500.00 5,034,003.48
- 5,149,156.37 17,500.00 5,131,656.37 377,350.00
- 5,075,916.70 17,500.00 5,058,416.70 2,312,500.00
- 4,653,279.12 17,500.00 4,635,779.12 550,000.00
- 4,535,651.77 17,500.00 4,518,151.77
- 4,240,657.61 17,500.00 4,223,157.61
- 4,281,716.21 17,500.00 4,264,216.21 1,465,300.00
- 4,249,535.14 17,500.00 4,232,035.14 2,439,000.00
- 4,603,820.31 17,500.00 4,586,320.31
- 3,564,935.57 12,500.00 3,552,435.57
- 4,731,150.71 12,500.00 4,718,650.71 1,488,000.00
- 3,562,599.37 12,500.00 3,550,099.37
- 3,875,091.64 17,500.00 3,857,591.64 1,464,600.00
- 3,974,963.91 17,500.00 3,957,463.91
- 4,362,891.34 12,500.00 4,350,391.34 1,150,000.00
- 2,490,171.23 5,000.00 2,485,171.23 870,100.00

Page 199 of 248
PAJAK D.WANITA, DLL
- 2,490,171.23 5,000.00 2,485,171.23
- 2,490,171.23 5,000.00 2,485,171.23
- 2,320,797.20 5,000.00 2,315,797.20
53,833.33 3,860,508.85 5,000.00 3,855,508.85 270,700.00
42,441.67 4,019,080.71 5,000.00 4,014,080.71
- 3,431,609.34 5,000.00 3,426,609.34 550,000.00
1,991.67 3,429,617.67 5,000.00 3,424,617.67
27,070.83 3,351,974.15 5,000.00 3,346,974.15
- -
- - -
- 4,361,782.79 27,500.00 4,334,282.79 900,000.00
- 3,987,647.19 27,500.00 3,960,147.19
- 4,067,703.85 4,067,703.85 108,500.00
- 3,913,565.49 17,500.00 3,896,065.49 2,156,200.00
- 4,128,478.38 17,500.00 4,110,978.38 1,889,000.00
- 3,794,663.42 17,500.00 3,777,163.42
- 3,665,736.85 17,500.00 3,648,236.85
- 3,951,129.98 17,500.00 3,933,629.98 1,650,000.00
- 3,415,516.12 17,500.00 3,398,016.12 401,800.00
- 3,704,576.06 17,500.00 3,687,076.06
- 3,462,451.03 17,500.00 3,444,951.03
- 3,647,074.39 17,500.00 3,629,574.39
- 3,723,344.86 12,500.00 3,710,844.86
- 3,589,333.13 17,500.00 3,571,833.13 196,000.00
- -
- -
- 1,898,543.53 27,500.00 1,871,043.53
- 1,859,237.50 12,500.00 1,846,737.50 480,400.00
- 1,157,060.56 5,000.00 1,152,060.56
- 1,157,060.56 5,000.00 1,152,060.56
- 1,157,060.56 5,000.00 1,152,060.56
- - -
- - -
- 3,716,227.26 17,500.00 3,698,727.26 930,000.00

Page 200 of 248
PAJAK D.WANITA, DLL
- 3,690,154.58 17,500.00 3,672,654.58
- 3,392,925.92 17,500.00 3,375,425.92 600,000.00
- 3,511,122.11 17,500.00 3,493,622.11 756,000.00
- 3,175,653.51 17,500.00 3,158,153.51
- 3,335,566.01 17,500.00 3,318,066.01 166,600.00
- 3,332,089.65 17,500.00 3,314,589.65
- 3,012,264.66 17,500.00 2,994,764.66 1,927,000.00
- 3,253,139.72 12,500.00 3,240,639.72
- 1,906,761.33 - 1,906,761.33
- 2,751,812.22 12,500.00 2,739,312.22 161,000.00
- 2,744,493.57 12,500.00 2,731,993.57
- 2,216,257.34 12,500.00 2,203,757.34 166,600.00
- 2,576,164.63 5,000.00 2,571,164.63
- 2,572,505.31 5,000.00 2,567,505.31
- 2,490,170.50 5,000.00 2,485,170.50 600,000.00
- 2,486,511.18 5,000.00 2,481,511.18
- 3,516,336.65 17,500.00 3,498,836.65 1,505,150.00
- 2,572,505.31 5,000.00 2,567,505.31 258,350.00
- 2,329,160.21 5,000.00 2,324,160.21
2,128,045.00 5,000.00 2,123,045.00
2,128,045.00 5,000.00 2,123,045.00
1,888,156.29 5,000.00 1,883,156.29
1,888,156.29 5,000.00 1,883,156.29
- - -
- - -
- 3,470,546.23 17,500.00 3,453,046.23 2,330,000.00
- 3,352,684.63 17,500.00 3,335,184.63 550,000.00
- 3,118,554.16 17,500.00 3,101,054.16 1,450,000.00
- 3,339,942.84 17,500.00 3,322,442.84 220,000.00
- 3,371,797.32 17,500.00 3,354,297.32 1,889,000.00
- 2,897,165.48 17,500.00 2,879,665.48
- 2,835,049.24 17,500.00 2,817,549.24 550,000.00
- 2,753,820.30 17,500.00 2,736,320.30 2,102,050.00
- 2,840,074.40 17,500.00 2,822,574.40

Page 201 of 248
PAJAK D.WANITA, DLL
- 2,753,820.30 17,500.00 2,736,320.30
- 2,825,492.89 17,500.00 2,807,992.89 880,000.00
- 2,858,599.40 17,500.00 2,841,099.40 210,750.00
- 2,091,765.03 12,500.00 2,079,265.03 379,750.00
- 1,547,308.60 5,000.00 1,542,308.60
- 2,275,080.91 5,000.00 2,270,080.91 1,150,000.00
- 2,345,886.07 5,000.00 2,340,886.07
- 1,972,605.66 12,500.00 1,960,105.66
- 1,498,558.60 5,000.00 1,493,558.60
- 2,524,887.14 12,500.00 2,512,387.14
- 2,275,080.91 5,000.00 2,270,080.91 839,350.00
- 2,278,434.01 5,000.00 2,273,434.01 550,000.00
- 2,543,589.20 5,000.00 2,538,589.20 1,150,000.00
- 2,345,886.07 5,000.00 2,340,886.07 550,000.00
- 2,202,989.18 5,000.00 2,197,989.18
- 1,323,705.18 5,000.00 1,318,705.18
- 1,828,837.29 5,000.00 1,823,837.29
- 2,127,544.34 5,000.00 2,122,544.34
- 2,127,544.34 5,000.00 2,122,544.34
- 2,454,731.95 5,000.00 2,449,731.95 942,000.00
- 2,278,434.01 5,000.00 2,273,434.01 1,150,000.00
- 2,278,434.01 5,000.00 2,273,434.01 300,000.00
- 2,199,636.07 5,000.00 2,194,636.07
- 2,221,691.24 5,000.00 2,216,691.24 550,000.00
- 2,367,291.26 5,000.00 2,362,291.26 550,000.00
- 2,120,838.13 5,000.00 2,115,838.13
- 2,120,838.13 5,000.00 2,115,838.13 149,850.00
- 1,407,395.11 5,000.00 1,402,395.11
- 2,367,291.26 5,000.00 2,362,291.26
- 2,206,342.28 5,000.00 2,201,342.28
- 2,202,989.18 5,000.00 2,197,989.18 149,850.00
- 2,202,989.18 5,000.00 2,197,989.18 1,100,000.00
- 2,498,192.30 5,000.00 2,493,192.30
- 2,267,088.13 5,000.00 2,262,088.13

Page 202 of 248
PAJAK D.WANITA, DLL
- 2,278,434.01 5,000.00 2,273,434.01
1,798,861.48 1,798,861.48
- - -
- - -
- 2,250,930.09 17,500.00 2,233,430.09
- 9,613,474.85 17,500.00 9,595,974.85
- 10,026,388.42 17,500.00 10,008,888.42
- 9,343,492.90 - 9,343,492.90
- 10,465,770.80 17,500.00 10,448,270.80
- 9,322,317.85 17,500.00 9,304,817.85
- 9,115,861.06 17,500.00 9,098,361.06
- 10,091,585.30 12,500.00 10,079,085.30
- 9,857,545.22 12,500.00 9,845,045.22
- 9,879,834.75 12,500.00 9,867,334.75
- 9,071,839.24 12,500.00 9,059,339.24
184,770.83 7,098,333.52 5,000.00 7,093,333.52 149,850.00
- 2,523,315.13 5,000.00 2,518,315.13
199,208.33 6,844,283.56 5,000.00 6,839,283.56
- - -
- - -
- 3,226,988.54 27,500.00 3,199,488.54
- 3,143,186.34 17,500.00 3,125,686.34
- 2,635,623.53 12,500.00 2,623,123.53
- 1,421,781.79 5,000.00 1,416,781.79 108,500.00
- - -
- - -
- 2,634,289.69 17,500.00 2,616,789.69 550,000.00
- 1,691,339.47 5,000.00 1,686,339.47
- - -
- - -
- 2,004,177.20 17,500.00 1,986,677.20
- - -
- - -
- 2,746,778.45 27,500.00 2,719,278.45

Page 203 of 248
PAJAK D.WANITA, DLL
- 2,833,680.08 17,500.00 2,816,180.08 900,000.00
- 2,198,545.61 17,500.00 2,181,045.61
- 2,213,171.88 17,500.00 2,195,671.88
- - -
- - -
- 2,720,638.13 27,500.00 2,693,138.13 900,000.00
- 1,936,107.93 5,000.00 1,931,107.93
- - -
- - -
- 3,204,804.57 27,500.00 3,177,304.57
- 3,254,427.14 17,500.00 3,236,927.14
- 2,572,316.19 17,500.00 2,554,816.19 330,000.00
- 2,632,708.94 12,500.00 2,620,208.94 1,450,000.00
- - -
- - -
- 2,646,334.22 27,500.00 2,618,834.22 550,000.00
- 2,733,292.86 17,500.00 2,715,792.86 600,000.00
- 2,491,240.06 17,500.00 2,473,740.06 880,000.00
- 1,937,782.25 17,500.00 1,920,282.25
- 2,118,641.93 17,500.00 2,101,141.93 377,350.00
- 2,446,293.54 12,500.00 2,433,793.54 1,316,666.00
- 2,423,390.85 12,500.00 2,410,890.85 1,826,266.00
- - -
- - -
- 3,161,487.81 17,500.00 3,143,987.81 1,700,000.00
- 2,693,576.64 17,500.00 2,676,076.64 1,450,000.00
- 2,216,060.25 17,500.00 2,198,560.25
- 2,324,028.64 12,500.00 2,311,528.64 550,000.00
- - -
- - -
- 3,282,675.15 17,500.00 3,265,175.15 550,000.00
- 2,683,026.14 17,500.00 2,665,526.14
- 2,361,942.69 17,500.00 2,344,442.69 600,000.00
- 2,558,790.53 12,500.00 2,546,290.53

Page 204 of 248
PAJAK D.WANITA, DLL
- - -
- - -
- 3,614,905.47 17,500.00 3,597,405.47 1,450,000.00
- 2,767,006.14 17,500.00 2,749,506.14 571,750.00
- 2,435,446.13 12,500.00 2,422,946.13
- 2,265,777.89 5,000.00 2,260,777.89
- 1,828,189.04 17,500.00 1,810,689.04
- - -
1,944,115.19 5,000.00 1,939,115.19
- - -
- - -
- 2,814,033.70 17,500.00 2,796,533.70 1,750,000.00
- 2,688,575.22 17,500.00 2,671,075.22 2,453,300.00
- - -
- - -
- 3,326,511.19 17,500.00 3,309,011.19 2,483,400.00
- 2,866,430.89 17,500.00 2,848,930.89 2,913,400.00
- - -
- - -
- 2,256,522.99 27,500.00 2,229,022.99
- 1,921,410.34 17,500.00 1,903,910.34
- - -
- - -
- 3,980,121.75 17,500.00 3,962,621.75 1,733,400.00
- 3,311,761.11 12,500.00 3,299,261.11 1,267,650.00
- 1,415,736.68 5,000.00 1,410,736.68
- 2,332,082.70 5,000.00 2,327,082.70
- - -
- - -
- 2,727,233.67 27,500.00 2,699,733.67
- 2,373,353.87 17,500.00 2,355,853.87 2,705,000.00
- 1,862,794.72 12,500.00 1,850,294.72 1,463,400.00
- - -
- - -

Page 205 of 248
PAJAK D.WANITA, DLL
- 2,793,056.63 17,500.00 2,775,556.63
- 1,881,226.95 12,500.00 1,868,726.95 1,000,000.00
- - -
- - -
- 1,972,170.29 12,500.00 1,959,670.29
- 1,348,447.71 5,000.00 1,343,447.71
- 1,466,216.06 5,000.00 1,461,216.06
- - -
- 4,608,141.56 17,500.00 4,590,641.56
- 3,289,593.99 17,500.00 3,272,093.99
- 3,483,836.79 17,500.00 3,466,336.79 2,390,600.00
39,441.67 3,587,019.08 5,000.00 3,582,019.08
- 716,284.98 716,284.98
- 3,291,143.22 5,000.00 3,286,143.22 268,350.00
- 2,309,671.50 5,000.00 2,304,671.50
- 2,554,971.82 5,000.00 2,549,971.82
- 2,630,971.87 5,000.00 2,625,971.87
2,153,851.60 5,000.00 2,148,851.60
2,153,851.60 5,000.00 2,148,851.60
- - -
- - -
- 3,320,887.34 12,500.00 3,308,387.34
- 3,330,232.12 12,500.00 3,317,732.12
974,713.82 5,000.00 969,713.82
- - -
- - -
- 3,079,186.81 17,500.00 3,061,686.81
- - -
- - -
- 2,169,655.44 12,500.00 2,157,155.44 205,800.00
- 1,850,758.56 12,500.00 1,838,258.56
- 1,649,178.54 5,000.00 1,644,178.54
- 1,649,178.54 5,000.00 1,644,178.54

Page 206 of 248
PAJAK D.WANITA, DLL
- 1,381,303.59 5,000.00 1,376,303.59
- 1,326,004.38 5,000.00 1,321,004.38
- - -
- - -
- 3,344,383.19 17,500.00 3,326,883.19
- 2,436,896.19 17,500.00 2,419,396.19
- 2,883,924.24 17,500.00 2,866,424.24
- 2,656,135.59 17,500.00 2,638,635.59
- 2,644,031.11 17,500.00 2,626,531.11 550,000.00
- 2,335,536.75 17,500.00 2,318,036.75 156,800.00
- 2,389,103.77 12,500.00 2,376,603.77
- 2,285,600.61 12,500.00 2,273,100.61 227,350.00
- 2,414,953.18 12,500.00 2,402,453.18
- 1,930,193.02 7,500.00 1,922,693.02 620,000.00
- 2,158,776.22 12,500.00 2,146,276.22 1,216,950.00
- 1,872,956.28 1,872,956.28
- 1,948,442.01 5,000.00 1,943,442.01
- - - -
- - -
- - -
- 3,954,900.69 17,500.00 3,937,400.69
- 3,625,001.68 17,500.00 3,607,501.68
- 3,318,833.55 17,500.00 3,301,333.55
- 2,979,160.98 17,500.00 2,961,660.98
- 2,927,005.46 17,500.00 2,909,505.46
- 2,935,883.00 17,500.00 2,918,383.00 755,600.00
- 2,739,360.69 17,500.00 2,721,860.69 377,200.00
- 2,684,985.79 17,500.00 2,667,485.79
- 2,741,580.07 17,500.00 2,724,080.07 755,600.00
- 2,737,141.31 17,500.00 2,719,641.31
- 2,687,205.17 17,500.00 2,669,705.17
- 2,535,177.37 12,500.00 2,522,677.37
- 3,107,924.61 12,500.00 3,095,424.61 600,000.00
- 2,369,518.76 12,500.00 2,357,018.76 755,600.00

Page 207 of 248
PAJAK D.WANITA, DLL
- 2,468,750.76 2,468,750.76
- 2,451,341.76 5,000.00 2,446,341.76
- 2,451,341.76 5,000.00 2,446,341.76
- 2,398,777.41 5,000.00 2,393,777.41
- 2,401,113.60 5,000.00 2,396,113.60
- 2,146,356.05 5,000.00 2,141,356.05
- 2,146,356.05 5,000.00 2,141,356.05
- 2,146,356.05 5,000.00 2,141,356.05
- 2,144,019.86 5,000.00 2,139,019.86
- 2,144,019.86 5,000.00 2,139,019.86
- 1,980,486.31 5,000.00 1,975,486.31
- 2,091,455.50 5,000.00 2,086,455.50
- 2,091,455.50 5,000.00 2,086,455.50
- - -
- - -
- 3,113,326.87 17,500.00 3,095,826.87 2,222,400.00
- 2,258,493.34 5,000.00 2,253,493.34
- 2,205,928.99 5,000.00 2,200,928.99
- 2,148,692.24 5,000.00 2,143,692.24
1,027,880.03 5,000.00 1,022,880.03
- - -
- - -
- 2,322,799.07 27,500.00 2,295,299.07
- 2,506,624.23 17,500.00 2,489,124.23
- 2,295,403.96 17,500.00 2,277,903.96
- 2,407,480.02 17,500.00 2,389,980.02
- 2,126,212.21 17,500.00 2,108,712.21
- 2,179,017.28 17,500.00 2,161,517.28
- 1,746,877.85 17,500.00 1,729,377.85
- 1,778,129.83 17,500.00 1,760,629.83
- 1,951,121.72 12,500.00 1,938,621.72 387,100.00
- 1,746,934.57 12,500.00 1,734,434.57 1,060,600.00
- 1,849,028.14 12,500.00 1,836,528.14
- 1,864,909.37 12,500.00 1,852,409.37 896,700.00

Page 208 of 248
PAJAK D.WANITA, DLL
- 1,647,109.73 12,500.00 1,634,609.73
- 1,480,356.89 12,500.00 1,467,856.89 519,400.00
- 1,482,625.63 12,500.00 1,470,125.63 1,148,350.00
- 1,469,013.16 7,500.00 1,461,513.16 1,022,800.00
- 1,471,281.90 7,500.00 1,463,781.90
- 1,366,919.58 7,500.00 1,359,419.58 838,150.00
- 1,480,356.89 12,500.00 1,467,856.89 330,000.00
- 1,378,263.31 7,500.00 1,370,763.31
- 1,284,761.44 - 1,284,761.44 609,300.00
- 1,292,050.95 5,000.00 1,287,050.95
- 1,334,022.76 5,000.00 1,329,022.76 630,000.00
- 1,331,754.01 5,000.00 1,326,754.01 330,000.00
- 1,331,754.01 5,000.00 1,326,754.01 1,033,900.00
- 1,280,707.22 5,000.00 1,275,707.22
- 1,278,438.48 5,000.00 1,273,438.48 1,452,050.00
- 1,280,707.22 5,000.00 1,275,707.22 599,500.00
- 1,280,707.22 5,000.00 1,275,707.22 352,800.00
- 1,354,441.47 5,000.00 1,349,441.47
- 1,222,722.91 5,000.00 1,217,722.91 283,350.00
- 1,229,660.43 5,000.00 1,224,660.43
- 1,178,613.65 5,000.00 1,173,613.65
- 1,455,085.39 5,000.00 1,450,085.39
- 1,298,857.19 5,000.00 1,293,857.19
- 1,329,485.27 5,000.00 1,324,485.27 433,400.00
627,425.16 5,000.00 622,425.16
627,425.16 5,000.00 622,425.16
627,425.16 5,000.00 622,425.16
- - -
- - -
- 1,868,652.80 17,500.00 1,851,152.80
- 1,817,265.70 12,500.00 1,804,765.70 352,800.00
- 1,678,872.18 12,500.00 1,666,372.18
- 1,761,681.42 12,500.00 1,749,181.42
- 1,347,635.24 7,500.00 1,340,135.24 330,000.00

Page 209 of 248
PAJAK D.WANITA, DLL
- 1,691,350.28 12,500.00 1,678,850.28 504,700.00
- 1,695,887.78 1,695,887.78
- 1,749,203.31 12,500.00 1,736,703.31
- 1,437,250.71 5,000.00 1,432,250.71
- 1,261,422.88 5,000.00 1,256,422.88
- 1,386,203.92 5,000.00 1,381,203.92 490,000.00
- 1,390,741.41 5,000.00 1,385,741.41
- 1,210,376.09 5,000.00 1,205,376.09 434,000.00
- 1,210,376.09 5,000.00 1,205,376.09 166,600.00
- 1,335,157.13 5,000.00 1,330,157.13
- 1,088,998.17 5,000.00 1,083,998.17
- 1,088,998.17 5,000.00 1,083,998.17 323,400.00
- 1,088,998.17 5,000.00 1,083,998.17
- 1,088,998.17 5,000.00 1,083,998.17
610,313.57 5,000.00 605,313.57
610,313.57 5,000.00 605,313.57
- -
- - -
- 2,474,294.59 17,500.00 2,456,794.59
- 2,298,693.64 27,500.00 2,271,193.64
- 2,106,814.43 17,500.00 2,089,314.43
- 1,866,497.49 1,866,497.49
- 2,067,962.15 12,500.00 2,055,462.15
- 1,761,681.42 12,500.00 1,749,181.42
- 1,812,728.20 12,500.00 1,800,228.20
- 1,699,290.90 12,500.00 1,686,790.90 330,000.00
- 1,546,150.53 12,500.00 1,533,650.53 775,000.00
- 1,534,806.80 7,500.00 1,527,306.80 775,000.00
- 1,279,572.85 7,500.00 1,272,072.85 330,000.00
- 1,446,325.70 7,500.00 1,438,825.70 176,400.00
- 1,397,547.65 5,000.00 1,392,547.65
- 1,397,547.65 5,000.00 1,392,547.65 824,400.00
- 1,914,821.78 12,500.00 1,902,321.78
- 1,590,391.08 7,500.00 1,582,891.08 330,000.00

Page 210 of 248
PAJAK D.WANITA, DLL
- 1,763,950.16 12,500.00 1,751,450.16
- 1,499,641.23 7,500.00 1,492,141.23 330,000.00
661,648.35 5,000.00 656,648.35
661,648.35 5,000.00 656,648.35
661,648.35 5,000.00 656,648.35
- - -
- - -
- 1,963,921.09 27,500.00 1,936,421.09
- 2,408,031.48 17,500.00 2,390,531.48
- 2,228,261.39 17,500.00 2,210,761.39 368,250.00
- 1,899,792.58 17,500.00 1,882,292.58
- 1,857,624.29 17,500.00 1,840,124.29
- 2,143,924.80 17,500.00 2,126,424.80
- 2,006,323.01 17,500.00 1,988,823.01 1,105,000.00
- 2,041,833.15 17,500.00 2,024,333.15 330,000.00
- 1,916,437.96 17,500.00 1,898,937.96
- 1,806,578.46 12,500.00 1,794,078.46 1,133,350.00
- 1,728,783.21 12,500.00 1,716,283.21 883,500.00
- 1,798,869.02 12,500.00 1,786,369.02
- 947,244.77 12,500.00 934,744.77
- 1,691,404.12 12,500.00 1,678,904.12 1,133,350.00
- 1,748,640.86 12,500.00 1,736,140.86
- 1,743,968.47 12,500.00 1,731,468.47 352,800.00
- 1,781,347.57 12,500.00 1,768,847.57
- 1,693,740.31 12,500.00 1,681,240.31 930,300.00
- 1,691,404.12 12,500.00 1,678,904.12 1,133,400.00
- 1,868,954.83 12,500.00 1,856,454.83
- 1,708,925.57 12,500.00 1,696,425.57 360,000.00
- 1,623,654.51 12,500.00 1,611,154.51 252,300.00
- 1,621,318.31 12,500.00 1,608,818.31 1,133,350.00
- 1,623,654.51 12,500.00 1,611,154.51 676,300.00
- 1,749,808.96 12,500.00 1,737,308.96
- 1,662,201.70 1,662,201.70
- 1,662,201.70 12,500.00 1,649,701.70

Page 211 of 248
PAJAK D.WANITA, DLL
- 1,662,201.70 12,500.00 1,649,701.70
- 1,524,366.28 7,500.00 1,516,866.28 1,255,000.00
- 1,588,611.60 12,500.00 1,576,111.60
- 1,678,555.05 5,000.00 1,673,555.05
- 1,680,891.25 5,000.00 1,675,891.25
- 1,444,935.70 5,000.00 1,439,935.70
- 1,444,935.70 5,000.00 1,439,935.70
- 1,369,009.41 5,000.00 1,364,009.41
- 1,404,052.31 5,000.00 1,399,052.31
- 1,369,009.41 5,000.00 1,364,009.41 900,000.00
- 1,444,935.70 5,000.00 1,439,935.70
- 1,263,880.70 5,000.00 1,258,880.70 525,000.00
- 1,298,923.60 5,000.00 1,293,923.60
- 1,263,880.70 5,000.00 1,258,880.70
- 1,263,880.70 5,000.00 1,258,880.70
- 1,263,880.70 5,000.00 1,258,880.70 742,300.00
6,004.17 1,614,146.05 5,000.00 1,609,146.05
- 1,518,525.80 5,000.00 1,513,525.80
- 1,555,904.89 5,000.00 1,550,904.89
- 1,501,004.34 5,000.00 1,496,004.34
1,138,642.96 5,000.00 1,133,642.96
1,138,642.96 5,000.00 1,133,642.96
1,096,110.00 5,000.00 1,091,110.00
1,096,110.00 5,000.00 1,091,110.00
- - -
- - -
- 2,058,319.98 17,500.00 2,040,819.98 273,800.00
- 1,949,476.88 17,500.00 1,931,976.88
- 1,759,809.70 12,500.00 1,747,309.70 592,000.00
- 1,616,385.55 12,500.00 1,603,885.55 330,000.00
- 1,625,556.64 1,625,556.64
- 1,625,556.64 12,500.00 1,613,056.64
- 1,689,081.54 12,500.00 1,676,581.54
- 1,880,790.59 12,500.00 1,868,290.59 516,700.00

Page 212 of 248
PAJAK D.WANITA, DLL
- 1,636,900.38 12,500.00 1,624,400.38 798,700.00
- 1,652,781.60 5,000.00 1,647,781.60
- 1,374,860.19 5,000.00 1,369,860.19
- 1,335,157.13 5,000.00 1,330,157.13
- 1,335,157.13 5,000.00 1,330,157.13
- 1,499,641.23 5,000.00 1,494,641.23
- 1,332,888.39 5,000.00 1,327,888.39
- 1,550,688.02 5,000.00 1,545,688.02
- -
- - -
- 1,795,958.88 17,500.00 1,778,458.88 258,500.00
- 2,403,169.40 17,500.00 2,385,669.40
- 1,267,094.75 5,000.00 1,262,094.75
- -
- - -
- 2,749,224.85 17,500.00 2,731,724.85
- 1,900,938.27 12,500.00 1,888,438.27 330,000.00
- 2,044,494.98 12,500.00 2,031,994.98 294,000.00
- 2,389,724.13 12,500.00 2,377,224.13 330,000.00
- 2,012,997.62 12,500.00 2,000,497.62 372,400.00
- 1,700,685.07 12,500.00 1,688,185.07 1,274,500.00
- 1,721,400.44 12,500.00 1,708,900.44 1,263,400.00
- 1,448,305.50 5,000.00 1,443,305.50 509,600.00
- - -
- - -
- 1,707,231.51 12,500.00 1,694,731.51 330,000.00
- 1,480,356.89 7,500.00 1,472,856.89
- 1,364,650.83 7,500.00 1,357,150.83 501,550.00
- 1,313,604.04 7,500.00 1,306,104.04 330,000.00
- -
- - -
- 1,762,815.79 12,500.00 1,750,315.79 149,850.00
- 1,950,554.54 17,500.00 1,933,054.54 438,500.00
- 1,982,884.17 17,500.00 1,965,384.17 330,000.00

Page 213 of 248
PAJAK D.WANITA, DLL
- 1,698,156.52 12,500.00 1,685,656.52 830,000.00
- 1,695,887.78 12,500.00 1,683,387.78 318,550.00
- 1,700,425.27 12,500.00 1,687,925.27 392,000.00
- 1,749,203.31 12,500.00 1,736,703.31 661,200.00
- 1,751,472.06 12,500.00 1,738,972.06 619,150.00
- 1,484,894.38 7,500.00 1,477,394.38 149,850.00
- 1,647,109.73 12,500.00 1,634,609.73
- 1,623,287.90 5,000.00 1,618,287.90 382,500.00
- 1,334,022.76 5,000.00 1,329,022.76
- 1,331,754.01 5,000.00 1,326,754.01 372,400.00
- 1,231,929.18 5,000.00 1,226,929.18
- 1,229,660.43 5,000.00 1,224,660.43 392,000.00
- 1,523,463.07 5,000.00 1,518,463.07 490,000.00
- 1,229,660.43 5,000.00 1,224,660.43 352,800.00
- 1,229,660.43 5,000.00 1,224,660.43
- 1,227,391.69 5,000.00 1,222,391.69 456,400.00
- - -
- - -
- 1,193,360.50 5,000.00 1,188,360.50 303,800.00
- 1,130,969.98 5,000.00 1,125,969.98
- - -
- - -
- 1,935,463.60 1,935,463.60
- 3,354,170.63 27,500.00 3,326,670.63
- 2,588,922.99 27,500.00 2,561,422.99
- 2,387,401.61 27,500.00 2,359,901.61 330,000.00
- 2,461,646.33 2,461,646.33
- 26,481,944.83 27,500.00 26,454,444.83
- 6,948,646.16 6,948,646.16
- 7,738,249.20 7,738,249.20
- 24,510,572.69 27,500.00 24,483,072.69
- 6,355,175.61 6,355,175.61
- 66,362,205.37 27,500.00 66,334,705.37 8,250,500.00
- 11,861,366.14 27,500.00 11,833,866.14

Page 214 of 248
PAJAK D.WANITA, DLL
- 13,864,151.50 27,500.00 13,836,651.50
- 9,724,720.13 27,500.00 9,697,220.13
- 2,025,333.20 27,500.00 1,997,833.20
- 2,211,914.10 27,500.00 2,184,414.10
- 35,827,383.90 27,500.00 35,799,883.90
- 13,354,679.71 27,500.00 13,327,179.71
- 4,094,896.28 27,500.00 4,067,396.28
- 22,135,823.90 27,500.00 22,108,323.90
- 15,635,402.72 17,500.00 15,617,902.72
- 2,775,118.59 27,500.00 2,747,618.59
- 5,467,683.24 17,500.00 5,450,183.24
- 968,811.34 968,811.34
- 15,166,401.21 17,500.00 15,148,901.21
- 7,468,626.17 17,500.00 7,451,126.17
- 8,494,407.58 17,500.00 8,476,907.58
- 12,511,370.34 17,500.00 12,493,870.34
- 10,544,223.23 17,500.00 10,526,723.23
- 17,397,542.73 17,500.00 17,380,042.73 2,833,500.00
- 1,276,269.46 17,500.00 1,258,769.46
- 33,772,673.90 33,772,673.90
- 47,862,805.36 17,500.00 47,845,305.36
- 2,942,372.00 27,500.00 2,914,872.00 264,550.00
- 4,975,730.94 17,500.00 4,958,230.94
- 2,580,554.85 17,500.00 2,563,054.85
- 11,740,051.52 17,500.00 11,722,551.52
- 71,653,440.72 17,500.00 71,635,940.72
109,921.67 2,746,511.89 5,000.00 2,741,511.89
- 35,084,249.75 17,500.00 35,066,749.75
- 13,071,827.59 27,500.00 13,044,327.59
- 118,047,462.04 17,500.00 118,029,962.04
- 38,550,009.67 17,500.00 38,532,509.67
- 25,498,848.92 17,500.00 25,481,348.92
- 21,584,640.26 17,500.00 21,567,140.26
- 14,993,792.09 17,500.00 14,976,292.09

Page 215 of 248
PAJAK D.WANITA, DLL
- 6,872,756.27 17,500.00 6,855,256.27
12,415,611.88 63,963,620.28 5,000.00 63,958,620.28
90,489.91 3,087,547.93 - 3,087,547.93
- 5,595,814.60 17,500.00 5,578,314.60
- 20,167,444.21 17,500.00 20,149,944.21
810,860.53 9,923,419.63 5,000.00 9,918,419.63
7,598,272.03 43,353,252.73 5,000.00 43,348,252.73
1,611,892.59 27,917,418.07 5,000.00 27,912,418.07
1,202,768.49 32,096,107.17 5,000.00 32,091,107.17
1,196,505.92 4,681,111.09 5,000.00 4,676,111.09
132,673.82 3,007,151.97 5,000.00 3,002,151.97
1,581,124.05 18,208,443.31 18,208,443.31
107,920.46 4,443,867.83 5,000.00 4,438,867.83
110,044.21 4,260,231.58 5,000.00 4,255,231.58
114,211.06 3,717,864.73 5,000.00 3,712,864.73
131,977.38 4,103,748.41 5,000.00 4,098,748.41
23,090.74 3,356,447.10 - 3,356,447.10
124,545.02 1,585,655.14 5,000.00 1,580,655.14
- 13,425,479.34 17,500.00 13,407,979.34
- 9,868,752.43 17,500.00 9,851,252.43
670,319.24 6,598,479.52 5,000.00 6,593,479.52 1,867,000.00
- 3,646,366.98 27,500.00 3,618,866.98
3,319,866.20 35,794,584.05 5,000.00 35,789,584.05
4,461,091.30 85,093,472.11 5,000.00 85,088,472.11
22,192.08 1,505,543.37 5,000.00 1,500,543.37
- 2,594,468.66 27,500.00 2,566,968.66
103,545.11 2,975,657.29 5,000.00 2,970,657.29
101,179.90 3,693,022.50 5,000.00 3,688,022.50
4,469,407.89 27,973,546.37 5,000.00 27,968,546.37
255,478.24 27,130,514.52 5,000.00 27,125,514.52
2,271.97 2,271.97
2,271.97 2,271.97
2,271.97 2,271.97
- 2,537,328.29 2,537,328.29

Page 216 of 248
PAJAK D.WANITA, DLL
- 173,764,500.00 17,500.00 173,747,000.00
- -
- -
3,500,000.00 3,500,000.00
1,650,000.00 1,650,000.00
3,927,661.47 3,927,661.47
- -
- -
41,319,752.22 3,590,386,851.08 9,497,500.00 3,580,889,351.08 289,647,886.00
3,580,889,351.08 289,647,886.00
SUD IBNU SINA KAB. GRESIK
G PUSPITOWATI, Sp. THT-KL

19601229 198901 2 001

Page 217 of 248
PTKP
PTK0
POTONGAN TAKE HOME KETERANGAN
STRUKTURAL PAY / TH
PTK3
PTK4
PK0
2,000,000.00 95,292,384.79 PK1
1,000,000.00 31,412,461.60 PK2
1,000,000.00 21,853,211.60 PK3
- PK4
- PK5
300,000.00 9,446,226.43 LTK0
250,000.00 7,896,764.57 LTK1
250,000.00 7,617,414.57 LTK2
250,000.00 6,877,564.57 LTK3
1,995,320.75 LTK4
1,744,328.62 LK0
1,356,811.92 LK1
1,838,220.95 LK2
1,371,962.82 LK3
1,853,543.74 LK4
518,225.33 LK5
1,996,474.75
1,018,994.26
1,336,741.17
1,015,287.96 TATA USAHA
1,579,719.21 TATA USAHA
1,152,834.75 TATA USAHA
1,199,038.36 TATA USAHA
1,295,625.63 TATA USAHA
959,637.96 TATA USAHA
1,479,894.38 LTK0
386,876.40 DRIVER
1,428,847.59 TATA USAHA
853,113.71 DRIVER
857,963.71 DRIVER
8,063.91 PTK0

Page 218 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
1,332,466.00 PTK0
1,373,263.31
-
-
300,000.00 10,123,976.43
250,000.00 7,027,368.30
250,000.00 6,927,368.30
1,829,187.64
(21,735.18)
1,488,426.98
1,666,239.96
1,736,065.64
1,674,639.33
952,912.91
938,322.09
800,228.20
1,534,259.40
1,683,212.61
1,785,306.19
1,549,356.58
1,547,087.84
1,581,119.03
980,387.84
915,287.96 KEUANGAN
1,530,766.00 KEUANGAN
1,479,719.21 KEUANGAN
1,349,266.31 KEUANGAN
1,583,387.78
326,441.54 KEUANGAN
1,384,256.71 KEUANGAN
1,360,610.04 KEUANGAN
(666,600.00) KEUANGAN
585,610.04 KEUANGAN
893,025.57 KEUANGAN

Page 219 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
-
-
10,446,968.09
300,000.00 7,882,704.09
250,000.00 7,896,764.57
803,529.97
1,582,816.84
1,606,352.98
1,751,450.16
1,281,178.14
1,861,929.34
1,751,450.16
445,403.37
1,030,119.03
1,598,309.79
1,137,856.89
-
1,524,927.43
1,533,650.53
1,516,634.93
1,204,765.70
671,365.70
1,289,112.49
1,331,869.59
1,364,188.33 PTK0
1,364,188.33 PTK0
966,288.36 LK1
814,815.01 LK1
499,385.27 LTK0
1,313,141.54 PTK0
1,332,425.88 LTK0
1,147,788.58 LTK0
936,110.34 LTK0
431,713.71 LTK0

Page 220 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
1,262,094.75 LTK0
2,368,684.46
1,978,537.89
585,306.19
781,434.41
600,909.40
202,165.82
834,259.40
206,125.45
536,794.20
1,222,391.69 KEUANGAN
1,424,310.10 PTK0
1,247,172.73 KEUANGAN
1,222,391.69 KEUANGAN
898,454.07 PTK0
1,139,888.61
947,750.10
1,513,925.57 LK2
1,511,656.83 PTK0
1,222,391.69 PTK0
1,296,125.94 PTK0
1,171,344.90 PTK0
1,169,076.15 LK0
1,169,076.15 PTK0
1,083,998.17 PTK0
LTK0
-
-
300,000.00 11,475,326.60
250,000.00 7,627,477.07
250,000.00 4,984,264.57
1,981,548.99
1,472,496.95
1,581,987.96 LK0

Page 221 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
1,428,847.59 TATA USAHA
1,426,578.85 LK0
1,424,310.10 PTK0
-
-
300,000.00 5,598,976.43
250,000.00 7,896,764.57
250,000.00 7,896,764.57
1,649,356.58
1,598,309.79
1,633,034.75 LK2
-
-
300,000.00 10,223,976.43
250,000.00 7,896,764.57
250,000.00 4,021,364.57
1,168,774.99
1,637,572.24 LTK0
1,386,875.79
-
-
2,045,897.78
2,003,102.07
1,424,310.10 PTK0
1,208,779.21 PTK0
-
-
2,789,771.72
2,205,889.75
1,606,027.12
355,944.27
1,914,413.21
385,398.71 PTK0
1,089,920.45 PTK0

Page 222 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
1,699,528.21 PTK0
1,844,108.73 PTK0
1,035,385.70 PTK0
1,092,456.95 LTK0
1,709,674.21 PTK0
1,523,241.44 PTK0
1,580,312.70 LTK0
1,466,170.18
1,139,057.96
1,139,057.96
-
-
4,130,848.43
4,138,197.14
3,304,118.23
3,309,891.77
2,241,618.20
1,610,353.23
3,142,446.54
3,131,423.47
2,244,337.28
2,590,491.46
2,605,726.95 PTK0
2,605,726.95 PTK0
2,518,702.72 PTK0
2,601,859.20 PTK0
2,867,035.13
2,105,143.15
571,034.97 PTK0
2,514,834.97 PTK0
1,458,110.38 PTK0
2,427,810.74 PTK0
1,960,967.23 PTK0
1,873,943.00 PTK0

Page 223 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
1,873,943.00 PTK0
2,336,918.77 PTK0
2,325,315.53 PTK0
2,325,315.53 PTK0
1,783,051.02 PTK0
2,333,051.02 PTK0
-
-
4,275,088.92
2,671,916.83
3,455,937.31
2,898,233.13
2,886,851.41
2,801,488.53
2,766,664.15
1,797,968.27
3,351,488.53
2,738,889.08
3,269,919.55
3,627,652.97
1,264,162.23
2,162,634.77 PTK0
1,202,634.09 PTK0
2,158,641.18 PTK0
2,908,320.45 PTK0
2,064,791.93 PTK0
2,618,785.52 PTK0
327,737.11 PTK0
2,064,791.93 PTK0
2,087,055.19
2,087,055.19
2,352,849.09
2,087,055.19
-

Page 224 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
-
2,469,634.40
1,862,498.10
2,696,709.90
1,796,275.30
1,725,494.07
1,496,867.88
1,816,933.74
779,430.09 PTK0
2,254,707.22 PTK0
2,254,707.22 LK1
1,571,611.94 PTK0
1,621,611.94 PTK0
1,156,391.76 PTK0
1,571,611.94 LTK0
1,455,421.40 LTK0
2,005,421.40 PTK0
2,268,851.10 LTK0
2,005,421.40 PTK0
2,005,421.40 PTK0
2,005,421.40 PTK0
1,718,749.87
1,718,749.87
-
- Ket:
3,414,310.66 - Umum Agt'17
3,648,694.69 - BPJS Juni'17
2,877,041.58 - Farmasi Agt'17
2,059,035.63 - Famasi BPJS Juni'17
2,175,147.18 - Ambulan Agt'17
1,782,141.08 PTK0
2,382,141.08 PTK0
2,382,141.08 LTK0
1,257,713.12 PTK0

Page 225 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
1,448,594.07 PTK0
1,648,594.07 PTK0
2,378,594.07 PTK0
1,278,594.07 PTK0
2,490,325.04 LTK0
1,413,970.56 LTK0
2,132,076.53 PTK0
2,135,623.54 PTK0
2,132,076.53 PTK0
2,132,076.53 PTK0
2,327,162.35 PTK0
2,327,162.35 PTK0
2,052,268.69 PTK0
2,052,268.69 PTK0
2,052,268.69 PTK0
2,052,268.69 PTK0
2,052,268.69 PTK0
1,956,341.17
-
- - Umum Agt'17
3,205,305.96 - BPJS Juni'17
2,014,357.45 - Farmasi Agt'17
1,582,638.46 - Ambulan Agt'17
2,871,483.51
1,138,296.87 PTK0
2,125,626.62 PTK0
1,835,545.39 LTK0
2,125,626.62 PTK0
1,686,249.74
2,482,793.91 PTK0
1,949,302.48
1,718,947.43
1,718,947.43

Page 226 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
1,718,947.43
1,718,947.43
-
-
2,089,229.70
2,675,328.44
473,401.75
1,963,058.30
958,368.27
1,955,499.83
1,778,806.35
1,777,386.51 PTK0
1,777,386.51 PTK0
1,839,037.08 PTK0
628,198.66 PTK0
1,648,605.31 PTK0
1,482,905.89 LTK0
1,160,255.89 LTK0
1,836,297.05 PTK0
1,922,607.85 LTK0
1,645,865.29 LTK0
1,645,865.29 PTK0
1,403,700.65 PTK0
1,645,865.29 PTK0
1,645,865.29 PTK0
-
-
2,402,181.94
1,892,568.28 PTK0
1,895,392.05 PTK0
878,726.05 PTK0
917,592.05 LTK0
1,851,623.73 PTK0
1,851,623.73 PTK0

Page 227 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
1,632,782.15 PTK0
1,480,802.55
1,480,802.55
-
-
2,158,009.80
499,123.62
1,104,890.86
1,236,297.05 PTK0
1,651,345.34 PTK0
672,437.08 PTK0
1,286,297.05 PTK0
1,645,865.29 PTK0
1,796,566.69 PTK0
1,584,214.72 PTK0
1,531,839.30 PTK0
8,371.08 PTK0
1,257,102.50
-
-
3,021,463.81
2,915,699.03
1,054,995.16
2,658,338.25
3,082,486.63
2,397,272.69 PTK0
1,888,029.33 PTK0
1,276,534.64 PTK0
2,400,977.04 LK0
2,400,977.04 PTK0
1,163,924.75 PTK0
2,230,576.82 LTK0
2,226,872.47 PTK0
2,430,611.86 PTK0

Page 228 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
2,143,524.53 PTK0
2,059,790.68
1,816,412.31
1,816,412.31
-
-
1,896,266.27
3,465,717.55
1,743,890.21
2,441,881.08
(270,000.36)
1,248,207.98
716,164.50 PTK0
2,469,416.84 PTK0
2,292,434.26 PTK0
639,094.97 PTK0
2,289,094.97 PTK0
2,060,353.33 PTK0
2,057,014.03 PTK0
1,981,879.92 PTK0
1,981,879.92 PTK0
1,646,307.90
1,981,879.92 PTK0
-
-
1,318,953.67
2,453,918.69
2,690,437.61
2,075,678.78
42,961.12
1,109,588.26 PTK0
2,179,512.32 LK0
1,626,148.94 PTK0
2,179,512.32 PTK0

Page 229 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
1,071,030.44 PTK0
2,024,797.05 PTK0
2,021,433.67 PTK0
2,021,433.67 PTK0
2,206,419.32
1,945,757.73
1,618,645.51
2,021,433.67 PTK0
2,206,419.32 PTK0
1,307,052.43 PTK0
-
-
4,049,199.91
5,300,329.54
3,082,580.96
5,124,520.89
5,112,791.61
5,267,038.79
5,034,003.48
4,754,306.37
2,745,916.70
4,085,779.12
4,518,151.77
4,223,157.61
2,798,916.21
1,793,035.14
4,586,320.31
3,552,435.57
3,230,650.71
3,550,099.37
2,392,991.64
3,957,463.91
3,200,391.34
1,615,071.23 LTK0

Page 230 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
2,485,171.23 LTK0
2,485,171.23 LK0
2,315,797.20 PTK0
3,584,808.85 PTK0
4,014,080.71 LK0
2,876,609.34 LK2
3,424,617.67 PTK0
3,346,974.15 PTK0
-
-
3,434,282.79
3,960,147.19
3,959,203.85
1,739,865.49
2,221,978.38
3,777,163.42
3,648,236.85
2,283,629.98
2,996,216.12
3,687,076.06
3,444,951.03
3,629,574.39
3,710,844.86
3,375,833.13
-
-
1,871,043.53
1,366,337.50
1,152,060.56 LTK0
1,152,060.56 LTK0
1,152,060.56 LTK0
-
-
2,768,727.26

Page 231 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
3,672,654.58
2,775,425.92
2,737,622.11
3,158,153.51
3,151,466.01
3,314,589.65
1,067,764.66
3,240,639.72
1,906,761.33
2,578,312.22
2,731,993.57
2,037,157.34
2,571,164.63 PTK0
2,567,505.31 PTK0
1,885,170.50 LTK0
2,481,511.18 PTK0
1,993,686.65
2,309,155.31 PTK0
2,324,160.21 PTK0
2,123,045.00
2,123,045.00
1,883,156.29
1,883,156.29
-
- Ket:
1,123,046.23 - Umum Agt'17
2,785,184.63 - BPJS Juni'17
1,651,054.16 - Farmasi Agt'17
1,465,297.32 - Ambulan Agt'17
2,879,665.48
2,267,549.24
634,270.30
2,822,574.40

Page 232 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
2,736,320.30
1,927,992.89
1,699,515.03
1,542,308.60 PTK0
1,120,080.91 PTK0
2,340,886.07 LK2
1,960,105.66
1,493,558.60 PTK0
2,512,387.14
1,430,730.91 LK1
1,723,434.01 LK1
1,388,589.20 LTK0
1,790,886.07 LTK0
2,197,989.18 LTK0
1,318,705.18 PTK0
1,823,837.29 PTK0
2,122,544.34 PTK0
2,122,544.34 PTK0
1,507,731.95 LTK0
1,123,434.01 PTK0
1,973,434.01 LTK0
2,194,636.07 LTK0
1,666,691.24 LTK0
1,812,291.26 LTK0
2,115,838.13 PTK0
1,965,988.13 PTK0
1,402,395.11 PTK0
2,362,291.26 PTK0
2,201,342.28 PTK0
2,048,139.18 PTK0
1,097,989.18 PTK0
2,493,192.30 PTK0
2,262,088.13 PTK0

Page 233 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
2,273,434.01 LK1
1,798,861.48
-
-
2,233,430.09
9,595,974.85
10,008,888.42
9,343,492.90
10,448,270.80
9,304,817.85
9,098,361.06
10,079,085.30
9,845,045.22
9,867,334.75
9,059,339.24
6,943,483.52 LK1
2,518,315.13 PTK0
6,839,283.56 LTK0
-
-
3,199,488.54
3,125,686.34
2,623,123.53 - Ambulan Agt'17
1,308,281.79 PTK0
-
-
2,066,789.69
1,686,339.47 PTK0
-
-
1,986,677.20
-
-
2,719,278.45

Page 234 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
1,916,180.08
2,181,045.61
2,195,671.88
-
-
1,793,138.13
1,931,107.93 PTK0
-
-
3,177,304.57
3,236,927.14
2,224,816.19
1,170,208.94
-
- Ket:
2,068,834.22 - Umum Agt'17
2,115,792.86 - BPJS Juni'17
1,593,740.06 - Farmasi Agt'17
1,920,282.25
1,723,791.93
1,117,127.54
584,624.85
-
- Ket:
1,443,987.81 - Umum Agt'17
1,226,076.64 - BPJS Juni'17
2,198,560.25 - Farmasi Agt'17
- - Ambulan Agt'17
-
2,715,175.15
2,665,526.14
1,744,442.69
2,546,290.53

Page 235 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
-
- Ket:
2,147,405.47 - Umum Agt'17
2,177,756.14 - BPJS Juni'17
2,422,946.13 - Farmasi Agt'17
1,810,689.04 - Ambulan Agt'17
-
1,939,115.19
-
-
1,046,533.70
217,775.22
-
-
825,611.19
(64,469.11)
-
-
2,229,022.99
1,903,910.34
-
-
2,229,221.75
2,031,611.11
1,410,736.68
2,327,082.70 PTK0
-
-
2,699,733.67
(349,146.13)
386,894.72
-
-

Page 236 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
2,775,556.63
868,726.95
-
-
1,959,670.29
1,343,447.71 PTK0
1,461,216.06 PTK0
- Ket:
4,590,641.56 - Umum Agt'17
3,272,093.99 - BPJS Juni'17
1,075,736.79 - Farmasi Agt'17
716,284.98 - Ambulan Agt'17
3,017,793.22 LK2
2,304,671.50 PTK0
2,549,971.82 PTK0
2,625,971.87 PTK0
2,148,851.60
2,148,851.60
-
-
3,308,387.34
3,317,732.12
969,713.82
-
-
3,061,686.81
-
-
1,951,355.44
1,838,258.56
1,644,178.54 LK1
1,644,178.54 LK0

Page 237 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
1,376,303.59 LK0
1,321,004.38 LK0
-
-
3,326,883.19 Ket:
2,419,396.19 - Umum Agt'17
2,866,424.24 - BPJS Juni'17
2,638,635.59 - Farmasi Agt'17
2,161,236.75 - Ambulan Agt'17
2,376,603.77
2,045,750.61
2,402,453.18
1,302,693.02
929,326.22
1,872,956.28 PTK0
1,943,442.01 PTK0
- PTK0
-
-
3,937,400.69
3,607,501.68
3,301,333.55
2,961,660.98
2,909,505.46
2,162,783.00
2,344,660.69
2,667,485.79
1,968,480.07
2,719,641.31
2,669,705.17
2,522,677.37
2,495,424.61
1,601,418.76

Page 238 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
2,468,750.76
2,446,341.76 PTK0
2,446,341.76 PTK0
2,393,777.41 PTK0
2,396,113.60 LTK0
2,141,356.05 PTK0
2,141,356.05 PTK0
2,141,356.05 LTK0
2,139,019.86 PTK0
2,139,019.86 PTK0
1,975,486.31 LTK0
2,086,455.50
2,086,455.50
-
-
873,426.87
2,253,493.34 PTK0
2,200,928.99 PTK0
2,143,692.24 LTK0
1,022,880.03
-
-
2,295,299.07
2,489,124.23
2,277,903.96
2,389,980.02
2,108,712.21
2,161,517.28
1,729,377.85
1,760,629.83
1,551,521.72
673,834.57
1,836,528.14
955,709.37

Page 239 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
1,634,609.73
948,456.89
321,775.63
438,713.16
1,463,781.90
521,269.58
1,137,856.89
1,370,763.31
675,461.44 LK1
1,287,050.95 PTK0
699,022.76 LTK0
996,754.01 PTK0
292,854.01 LK1
1,275,707.22 LTK0
(178,611.52) PTK0
676,207.22 LTK0
922,907.22 PTK0
1,349,441.47 PTK0
934,372.91 PTK0
1,224,660.43 PTK0
1,173,613.65 PTK0
1,450,085.39 PTK0
1,293,857.19 PTK0
891,085.27 LTK0
622,425.16
622,425.16
622,425.16
-
-
1,851,152.80
1,451,965.70
1,666,372.18
1,749,181.42
1,010,135.24

Page 240 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
1,174,150.28
1,695,887.78
1,736,703.31
1,432,250.71 LK1
1,256,422.88 LK2
891,203.92 LTK0
1,385,741.41 PTK0
771,376.09 LTK0
1,038,776.09 LTK0
1,330,157.13 PTK0
1,083,998.17 PTK0
760,598.17 PTK0
1,083,998.17 PTK0
1,083,998.17 PTK0
605,313.57
605,313.57
-
-
2,456,794.59
2,271,193.64
2,089,314.43
1,866,497.49
2,055,462.15
1,749,181.42
1,800,228.20
1,356,790.90
758,650.53
752,306.80
942,072.85
1,262,425.70
1,392,547.65 PTK0
568,147.65 PTK0
1,902,321.78
1,252,891.08

Page 241 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
1,751,450.16
1,162,141.23
656,648.35
656,648.35
656,648.35
-
-
1,936,421.09
2,390,531.48
1,842,511.39
1,882,292.58
1,840,124.29
2,126,424.80
883,823.01
1,694,333.15
1,898,937.96
660,728.46
832,783.21
1,786,369.02
934,744.77
545,554.12
1,736,140.86
1,378,668.47
1,768,847.57
750,940.31
545,504.12
1,856,454.83
1,336,425.57
1,358,854.51
475,468.31
934,854.51
1,737,308.96
1,662,201.70
1,649,701.70

Page 242 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
1,649,701.70
261,866.28
1,576,111.60
1,673,555.05 PTK0
1,675,891.25 PTK0
1,439,935.70 PTK0
1,439,935.70 PTK0
1,364,009.41 LK1
1,399,052.31 PTK0
464,009.41 PTK0
1,439,935.70 PTK0
733,880.70 LTK0
1,293,923.60 LTK0
1,258,880.70 PTK0
1,258,880.70 PTK0
516,580.70 PTK0
1,609,146.05 PTK0
1,513,525.80 PTK0
1,550,904.89 PTK0
1,496,004.34 PTK0
1,133,642.96
1,133,642.96
1,091,110.00
1,091,110.00
-
-
1,767,019.98
1,931,976.88
1,155,309.70
1,273,885.55
1,625,556.64
1,613,056.64
1,676,581.54
1,351,590.59

Page 243 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
825,700.38
1,647,781.60 LK0
1,369,860.19 LTK0
1,330,157.13 PTK0
1,330,157.13 PTK0
1,494,641.23 PTK0
1,327,888.39 LK0
1,545,688.02 PTK0
-
-
1,519,958.88
2,385,669.40 LTK5
1,262,094.75 LTK0
-
-
2,731,724.85
1,558,438.27
1,737,994.98
2,047,224.13
1,628,097.62
413,685.07
445,500.44
933,705.50 LK0
-
-
1,364,731.51
1,472,856.89
855,600.83
976,104.04
-
-
1,600,465.79
1,494,554.54
1,635,384.17

Page 244 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
855,656.52
1,364,837.78
1,295,925.27
1,075,503.31
1,119,822.06
1,327,544.38
1,634,609.73
1,235,787.90 LTK0
1,329,022.76 LTK0
954,354.01 LK0
1,226,929.18 LK2
832,660.43 LK2
1,028,463.07 LK2
871,860.43 LTK0
1,224,660.43 LTK0
765,991.69 LTK0
-
-
884,560.50 PTK0
1,125,969.98 PTK0
-
-
1,935,463.60
3,326,670.63
2,561,422.99
2,029,901.61
2,461,646.33
26,454,444.83
6,948,646.16
7,738,249.20
24,483,072.69
6,355,175.61
58,084,205.37
11,833,866.14

Page 245 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
13,836,651.50
9,697,220.13
1,997,833.20
2,184,414.10
35,799,883.90
13,327,179.71
4,067,396.28
22,108,323.90
15,617,902.72
2,747,618.59
5,450,183.24
968,811.34
15,148,901.21
7,451,126.17
8,476,907.58
12,493,870.34
10,526,723.23
14,546,542.73
1,258,769.46
33,772,673.90
47,845,305.36
2,650,322.00
4,958,230.94
2,563,054.85
11,722,551.52
71,635,940.72
2,741,511.89 LK1
35,066,749.75
13,044,327.59
118,029,962.04
38,532,509.67
25,481,348.92
21,567,140.26
14,976,292.09

Page 246 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
6,855,256.27
63,958,620.28 LK2
3,087,547.93 LK1
5,578,314.60
20,149,944.21
9,918,419.63 LK3
43,348,252.73 LK1
27,912,418.07 PTK0
32,091,107.17 PTK0
4,676,111.09 PTK0
3,002,151.97 PTK0
18,208,443.31 PTK0
4,438,867.83 PTK0
4,255,231.58 PTK0
3,712,864.73 PTK0
4,098,748.41 PTK0
3,356,447.10 PTK0
1,580,655.14 PTK0
13,407,979.34
9,851,252.43
4,726,479.52 PTK0
3,618,866.98
35,789,584.05 PTK0
85,088,472.11 PTK0
1,500,543.37 PTK0
2,566,968.66
2,970,657.29 PTK0
3,688,022.50 PTK0
27,968,546.37 PTK0
27,125,514.52 PTK0
2,271.97
2,271.97
2,271.97
2,537,328.29

Page 247 of 248
PTKP
PTK0
STRUKTURAL PAY / TH
PTK3
173,747,000.00
-
- YANG TUNAI :
3,500,000.00 M. MUSTA'IN
1,650,000.00 M. MISBACH
3,927,661.47 Dr. POEDJO
8,800,000.00 3,282,441,465.08 ###
GRESIK, OKTOBER 2017
PPTK
Penyedia Jasa Operasional
RSUD Ibnu Sina Kab. Gresik
LISTI AJOENI, SE.,M.Kes

NIP. 19600930 198102 2 003

Page 248 of 248

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SKOR INDIVIDU REMUNERAS

DATA KARYAWAN PER UNIT KERJA

DIREKSI RSUD KAB. GRESIK

1 BAGIAN TATA USAHA

MOHON KOREKSI DAN PARAF

MOHON KOREKSI DAN PARAF

III BAGIAN RENGRAM

MOHON KOREKSI DAN PARAF

MOHON KOREKSI DAN PARAF

V BIDANG PENUNJANG MEDIK

MOHON KOREKSI DAN PARAF

MOHON KOREKSI DAN PARAF

III RUANG NEONATUS

MOHON KOREKSI DAN PARAF

MOHON KOREKSI DAN PARAF

MOHON KOREKSI DAN PARAF

VII RUANG FLAMBOYAN

VIII RUANG OBSERVASI LANJUTAN

MOHON KOREKSI DAN PARAF

MOHON KOREKSI DAN PARAF

XII RUANG WIJAYA KUSUMA

MOHON KOREKSI DAN PARAF

XIII INSTALASI BEDAH SENTRAL / OK

MOHON KOREKSI DAN PARAF

XV UNIT STERILISASI SENTRAL

MOHON KOREKSI DAN PARAF

XVI INSTALASI GAWAT DARURAT

MOHON KOREKSI DAN PARAF

MOHON KOREKSI DAN PARAF

XVII UNIT HEMODIALISA

POLI TUMBUH KEMBANG

MOHON KOREKSI DAN PARAF

MOHON KOREKSI DAN PARAF

POLI KULIT KELAMIN

MOHON KOREKSI DAN PARAF

INSTALASI REHABILITASI MEDIS

UNIT PATOLOGI ANATOMI

XV INSTALASI KEDOKTERAN FORENSIK

MOHON KOREKSI DAN PARAF

XVI INSTALASI RADIOLOGI

MOHON KOREKSI DAN PARAF

UNIT BANK DARAH

XVIII INSTALASI GIZI

MOHON KOREKSI DAN PARAF

MOHON KOREKSI DAN PARAF

MOHON KOREKSI DAN PARAF

XXI INSTALASI FARMASI

MOHON KOREKSI DAN PARAF

MOHON KOREKSI DAN PARAF

XXIII UNIT K3RS

XXIV SOPIR AMBULANCE

MOHON KOREKSI DAN PARAF

XXVI STAF KOMITE MEDIK

XXVII KELOMPOK MEDIS

MOHON KOREKSI DAN PARAF

MOHON KOREKSI DAN PARAF

MOHON KOREKSI DAN PARAF

Plt Kabag Rengram

Akhmad Munif, S.Sos

1 BPJS JULI 2017 925,771,569.00 925,771

MOHON KOREKSI DAN PARAF

PENDIDIKAN SERTIFIKAT RESIKO KERJA KEDARURATAN KERJA JABAT

S2 Mag.Sain 8 LPJ + Diklat 3.4 11.4 2 22.8 Manj. 1 3 3 Manj. 1 3 3 Kabag T.

MOHON KOREKSI DAN PARAF