VARIABEL Formulasi Perhitungan Pajak

Variabel Daerah Total Nilai

No NAMA Jenis Status Penambah Kinerja Insentif Jumlah diterima
Kehadiran Masa Kerja Beban A B C
Ketenagaan Kepegawaian Tugas Adm Kompetensi Pengurang PPh 21
Kerja
1 dr HENDRIYANTO.MARS 150 24 10 15.00 35 0 20 144 24 80.00 248.00 66,667 10,000 56,667

2 drg SRI ARIANI 150 19 10 8.00 25 0 5 114 19 48.00 181.00 48,656 2,433 46,223
3 dr.MUJIANTI.K 150 18 10 6.00 0 5 108 18 21.00 147.00 39,516 1,976 37,540
4 YANI GANESWATI 25 24 10 34.00 5 5 24 24 54.00 102.00 27,419 1,371 26,048
5 ENI ASTUTI 25 24 10 33.00 5 5 24 24 53.00 101.00 27,151 1,358 25,793
6 ROKANAH 40 25 10 32.00 5 5 40 25 52.00 117.00 31,452 1,573 29,879
7 ENOK ROSTIATIN 40 25 10 31.00 25 0 0 40 25 66.00 131.00 35,215 1,761 33,454
8 SUKAMI 40 25 10 28.00 5 0 40 25 43.00 108.00 29,032 1,452 27,581
9 DEDEH RUSTIAWATI 25 25 10 24.00 30 10 20 25 25 94.00 144.00 38,710 1,935 36,774
10 SRI SUSANTI 25 21 10 31.00 10 5 21 21 56.00 98.00 26,344 1,317 25,027
11 NURMINI 25 21 10 30.00 5 0 21 21 45.00 87.00 23,387 1,169 22,218
12 DJUANINGSIH 25 24 10 25.00 5 0 24 24 40.00 88.00 23,656 1,183 22,473
13 PUJI HARTATI 25 25 10 27.00 5 0 25 25 42.00 92.00 24,731 1,237 23,495
14 JOMANSEN PURBA 25 20 10 29.00 5 5 20 20 49.00 89.00 23,925 1,196 22,728
15 DINAH ROHMAWATI 15 21 10 32.00 5 0 12.6 21 47.00 80.60 21,667 21,667
16 MEGA ROBAENI 40 25 5 5.00 5 5 40 25 20.00 85.00 22,849 571 22,278
17 NENENG MARLINA.T 40 24 5 8.00 5 5 38.4 24 23.00 85.40 22,957 574 22,383
18 SITI AMINAH 38 23 5 9.00 5 5 34.96 23 24.00 81.96 22,032 551 21,481
19 NURUL.U.H 60 25 10 5.00 25 5 0 60 25 45.00 130.00 34,946 1,747 33,199
20 ELI HARYATI 40 25 10 14.00 5 5 40 25 34.00 99.00 26,613 26,613
21 AGUS TAMI 25 24 5 11.00 5 5 24 24 26.00 74.00 19,892 497 19,395
22 NANY.R 40 25 5 3.00 5 0 40 25 13.00 78.00 20,968 524 20,444
23 INDAH.P 40 24 5 7.00 5 0 38.4 24 17.00 79.40 21,344 534 20,810
24 KUSNADI 15 25 0 0.00 5 0 15 25 5.00 45.00 12,097 302 11,794
25 RAHMATULLOH 15 20 0 0.00 5 0 12 20 5.00 37.00 9,946 249 9,698
26 MILA 15 20 0 0.00 0 0 12 20 0.00 32.00 8,602 215 8,387
27 VELA YATI KESUMA 40 24 0 0.00 5 5 38.4 24 10.00 72.40 19,462 487 18,976
28 RATNA AMALIA 40 24 5 6.00 10 5 0 38.4 24 26.00 88.40 23,763 594 23,169

Jumlah 2801.16 753,000 36,805 716,195

susulan maret 2016

Cibinong, 11 Mei 2016
Kepala Puskesmas
 dr. HENDRIYANTO.MARS
NIP. 197011062001121005
 JASA PELAYANAN FKTP PUSKESMAS JAMPANG BULAN JUNI 2018

Jmlh hari 16 Total Dana 78932910

BULAN : JUNI 2018
VARIABEL Formulasi Perhitungan
Total Pajak
No NAMA Persentase Jenis Rangkap Tanggung Penambah Point Sebelum PPH 21 Jumlah diterima TANDA
Kehadiran (A) Masa Kerja
Ketenagaan © Tugas Adm Jawab Prog Pengurang ( G)
(B) (D) (E) (F) (A X ( B+C+D+E+))/ XG PPh 21
TANGAN

1 dr,Vera Linda C.B 16 1.00 150 15.00 100.00 10.00 10 275.00 8,923,785 1,338,568 7,585,218
1

2 dr.Rismaini 14 0.88 150 10.00 10.00 10 148.75 4,826,957 241,348 4,585,609

2

3 dr.Bambang 15 0.94 150 10.00 5.00 10 159.38 5,171,739 258,587 4,913,152

3

4 Noli Haryono 16 1.00 60 25.00 10.00 5 90.00 2,920,512 146,026 2,774,486

4

5 Ni nyoman suardi 16 1.00 80 25.00 10.00 15 120.00 3,894,015 194,701 3,699,315

5

6 Kurniati 16 1.00 60 25.00 10.00 5 90.00 2,920,512 146,026 2,774,486

6

7 Indrawati 16 1.00 80 20.00 10.00 20 120.00 3,894,015 194,701 3,699,315

7

8 Siti Rogayah 16 1.00 60 20.00 50.00 5.00 15 145.00 4,705,269 235,263 4,470,005
8

9 Arif Irsiyyadi 16 1.00 60 20.00 30.00 10.00 15 125.00 4,056,266 202,813 3,853,453
9

10 Runi Khaerunisa 16 1.00 80 5.00 5.00 20 105.00 3,407,264 170,363 3,236,900

10

11 Dewi Komala 16 1.00 80 10.00 10.00 5 95.00 3,082,762 154,138 2,928,624

11

12 Lely Mauli 16 1.00 60 10.00 10.00 15 85.00 2,758,261 137,913 2,620,348

12

13 Kasuhaevi 16 1.00 60 5.00 10.00 10 75.00 2,433,760 121,688 2,312,072

13

14 Lusi Nurwiyanih 16 1.00 60 5.00 10.00 10 75.00 2,433,760 121,688 2,312,072

14

15 Ismawati Diah 16 1.00 60 5.00 10.00 10 75.00 2,433,760 0 2,433,760

15

16 Musdalifah 14 0.88 60 5.00 5.00 5 61.25 1,987,570 0 1,987,570

16

17 Retno Asri Fitriani 16 1.00 60 0.00 10.00 10 70.00 2,271,509 0 2,271,509

17

18 Pepen Komarudin 15 0.94 50 25.00 10.00 20 89.06 2,890,090 144,504 2,745,585

18

19 drg taufik 16 1.00 150 0.00 10.00 5 155.00 5,029,770 251,488 4,778,281
19

20 Rama yanti 16 1.00 60 5.00 10.00 15 80.00 2,596,010 129,801 2,466,210

20

21 Yanti Prihatin 16 1.00 60 10.00 10.00 10 80.00 2,596,010 129,801 2,466,210

21
22 Ika 16 1.00 60 0.00 5.00 0 60.00 1,947,008 116,820 1,830,187
22

23 Leny 16 1.00 25 0.00 0.00 -11 14.00 454,302 27,258 427,044

23

24 Zaenudin 16 1.00 25 0.00 0.00 -15 10.00 324,501 19,470 305,031

24

25 Entong Saputra 16 1.00 25 0.00 0.00 -15 10.00 324,501 19,470 305,031
25

26 Yogi 16 1.00 25 0.00 0.00 -15 10.00 324,501 19,470 305,031

26

27 Asep 16 1.00 25 0.00 0.00 -15 10.00 324,501 19,470 305,031

27

Jumlah 2432.44 78,932,910 4,541,375 74,391,535

Mengetahui/Menyetujui
Kepala Puskesmas Jampang Bendahara JKN Puskesmas Jampang

( dr.Vera Linda C.B ) Siti Rogayah

NIP 196611182002122003 NIP 197112151992032003
 JASA PELAYANAN FKTP PUSKESMAS JAMPANG BULAN MARET 2017

Jmlh hari 26 Total Dana 56247600

BULAN : MARET 2017

Formulasi
VARIABEL Perhitungan
Persentase Pajak
No NAMA Kehadiran Kehadiran Total Point Jumlah potongan 7% yang di terima
Jenis Rangkap Tanggung Penambah ( G) Sebelum PPH 21 diterima TANDA
(A) Masa Kerja (A X
Ketenagaan © Tugas Adm Jawab Prog Pengurang
(B) (D) (E) (F) ( B+C+D+E+))/ PPh 21
XG TANGAN

1 dr,Vera Linda C.B 26 1.00 150 17.00 100.00 10.00 278.00 7,295,520 1,094,328 6,201,192 434,083 5,767,109 1

2 dr.Rismaini 24 0.92 150 14.00 10.00 174.92 4,388,662 219,433 4,169,229 291,846 3,877,383 2

3 Cucu Mariam 10 0.38 80 27.00 15.00 5.00 127.38 1,334,675 66,734 1,267,941 88,756 1,179,185 3

4 Noli Haryono 26 1.00 60 27.00 5.00 93.00 2,513,812 125,691 2,388,122 167,169 2,220,953 4

5 Ni nyoman suardi 26 1.00 80 27.00 10.00 118.00 3,196,913 159,846 3,037,068 212,595 2,824,473 5

6 Kurniati 26 1.00 60 26.00 5.00 92.00 2,486,488 124,324 2,362,164 165,351 2,196,812 6

7 Indrawati 25 0.96 80 25.00 5.00 110.96 2,890,043 144,502 2,745,541 192,188 2,553,353 7

8 Siti Rogayah 26 1.00 80 25.00 50.00 5.00 161.00 4,371,847 218,592 4,153,255 290,728 3,862,527 8

9 Arif Irsiyyadi 26 1.00 60 25.00 15.00 20.00 121.00 3,278,886 163,944 3,114,941 218,046 2,896,895 9

10 Runi Khaerunisa 26 1.00 80 8.00 5.00 94.00 2,541,136 127,057 2,414,079 168,986 2,245,094 10

11 Dewi Komala 25 0.96 60 15.00 5.00 80.96 2,101,850 105,092 1,996,757 139,773 1,856,984 11

12 Lely Mauli 24 0.92 60 12.00 15.00 87.92 2,194,331 109,717 2,084,615 145,923 1,938,692 12

13 Kasuhaevi 20 0.77 60 9.00 5.00 5 79.77 1,660,461 0 1,660,461 116,232 1,544,229 13

14 Ismawati Diah 26 1.00 60 8.00 10.00 5 84.00 2,267,896 0 2,267,896 158,753 2,109,143 14

15 Musdalfah 25 0.96 60 5.00 5.00 70.96 1,839,118 0 1,839,118 128,738 1,710,380 15

16 drg taufik 26 1.00 150 3.00 5.00 159.00 4,317,199 215,860 4,101,339 287,094 3,814,246 15

17 Rama yanti 26 1.00 60 8.00 5.00 10 84.00 2,267,896 113,395 2,154,501 150,815 2,003,686 16

18 Yanti Prihatin 26 1.00 60 12.00 10.00 83.00 2,240,572 112,029 2,128,543 148,998 1,979,545 17

19 Ika 24 1.00 60 0.00 5.00 66.00 1,776,063 88,803 1,687,260 118,108 1,569,152 18
20 Leny 26 1.00 25 0.00 0.00 -10 16.00 409,861 20,493 389,368 389,368 19

21 Deden A Mukti 26 1.00 25 0.00 0.00 -13 13.00 327,889 19,673 308,215 308,215 20

22 Jaenudin 26 1.00 25 0.00 0.00 -15 11.00 273,240 16,394 256,846 256,846 21

23 Entong Saputra 26 1.00 25 0.00 0.00 -15 11.00 273,240 16,394 256,846 256,846 22

2068.54 56,247,600 3,262,302 52,985,298 3,624,182 49,361,116

Jumlah
52,985,298
Mengetahui/Menyetujui
Kepala UPF Puskesmas Jampang Bendahara JKN UPF Puskesmas Jampang

( dr.Vera Linda C.B ) ( Siti Rogayah )

NIP 196611182002122003 NIP 197112151992032003
7,295,520 6,201,192 0

4,388,662 4,169,229 0

1,334,675 1,267,941 0
2,513,812 2,388,122 0
3,196,913 3,037,068 0

2,486,488 2,362,164 0

2,890,043 2,745,541 0

4,371,847 4,153,255 0

3,278,886 3,114,941 0

2,541,136 2,414,079 0

2,101,850 1,996,757 0

2,194,331 2,084,615 0

1,660,461 1,660,461 0

2,267,896 2,267,896 0

1,839,118 1,839,118 0

4,317,199 4,101,339 0

2,267,896 2,154,501 0

2,240,572 2,128,543 0

1,776,063 1,687,260 0
 409,861 389,368 0

327,889 308,215 0

273,240 256,846 0

273,240 256,846 0
56,247,600 52,985,298 0
0
 JASA PELAYANAN FKTP PUSKESMAS JAMPANG SUSULAN MEI 2018
Jmlh hari 24 Total Dana 1179640
BULAN : susulan Mei 2018

Formulasi
VARIABEL
Persentas Perhitungan Pajak
Total
Kehadira e
No NAMA
n Kehadiran Jenis Rangkap Tanggung Penamba Point Sebelum PPH 21 Jumlah diterima TANDA
Ketenaga Masa Kerja Tugas Adm Jawab Prog h ( G)
(A) © Penguran (A X ( B+C+D+E+))/
an (B) (D) (E) PPh 21
g (F) XG TANGAN
1 dr,Vera Linda C.B 24 1.00 150 15.00 100.00 10.00 10 275.00 142,911 21,437 121,474 1

2 dr.Rismaini 24 1.00 150 14.00 10.00 10 174.00 90,423 4,521 85,902 2

3 Noli Haryono 24 1.00 60 27.00 15.00 5.00 10 112.00 58,204 2,910 55,293 3

4 Ni nyoman suardi 24 1.00 80 27.00 5.00 10 117.00 60,802 3,040 57,762 4

5 Kurniati 24 1.00 60 27.00 10.00 10 97.00 50,408 2,520 47,888 5

6 Indrawati 24 1.00 80 26.00 5.00 20 126.00 65,479 9,822 55,657 6

7 Siti Rogayah 20 0.83 80 25.00 10.00 10 95.83 49,802 2,490 47,312 7

8 Arif Irsiyyadi 24 1.00 60 25.00 50.00 5.00 10 145.00 75,353 3,768 71,585 8

9 Runi Khaerunisa 24 1.00 80 25.00 15.00 20.00 20 140.00 72,754 3,638 69,117 9

10 Dewi Komala 23 0.96 80 8.00 5.00 5 89.13 46,316 2,316 44,000

10

11 Lely Mauli 20 0.83 60 15.00 10.00 10 70.83 36,810 1,841 34,970

11

12 Kasuhaevi 24 1.00 60 12.00 15.00 10 82.00 42,613 2,131 40,483

12

13 Lusi Nurwianih 7 0.29 60 9.00 5.00 10 23.04 11,974 599 11,375

13

14 Ismawati Diah 24 1.00 60 8.00 10.00 15 83.00 43,133 0 43,133

14

15 Retno Asri Fitriani 23 0.96 150 5.00 5.00 10 158.13 82,174 0 82,174
15

16 Pepen Komarudin 17 0.71 50 27.00 10.00 20 68.71 35,706 1,785 33,921

16

17 drg taufik 24 1.00 150 8.00 10.00 5 163.00 84,707 4,235 80,472
17

18 Rama yanti 21 0.88 60 12.00 10.00 10 71.75 37,287 1,864 35,422

18

19 Yanti Prihatin 23 0.96 60 0.00 0.00 5 62.29 32,371 1,619 30,753

19
20 Ika 23 0.96 60 0.00 0.00 0 57.50 29,881 1,793 28,088
20
21 Leny 24 1.00 25 0.00 0.00 -5 20.00 10,393 624 9,770 21

22 Zaenudin 23 0.96 25 0.00 0.00 -15 9.58 4,980 299 4,681

22

22 Entong Saputra 23 0.96 25 0.00 0.00 -15 9.58 4,980 299 4,681
23

23 Yogi 23 0.96 25 0.00 0.00 -15 9.58 4,980 299 4,681

24

25 Asep 24 1.00 25 0.00 0.00 -15 10.00 5,197 312 4,885

25

2269.96 1,179,640 74,160 1,105,480

Jumlah
Jan-00 1,179,640
Mengetahui/Menyetujui
Kepala UPF Puskesmas Jampang Bendahara JKN UPF Puskesmas Jampang

( dr.Vera Linda C.B ) ( Siti Rogayah )

NIP 196611182002122003 NIP 197112151992032003
Kode Program :16 Kode Kegiatan :0318 Kode Rekening :5.2.2.03.12

DAFTAR PENERIMAAN JASA PELAYANAN DANA KAPITASI JKN PUSKESMAS JAMPANG

BULAN : MEI 2018

No NAMA NIP GOL NPWP JUMLAH (Rp) POT.PAJAK PPH 21 JUMLAH DITERIMA (Rp) Tanda Tangan
1 2 3 4 5 6 7 8 9

1 dr,Vera Linda C.B 8,923,785 1,338,568 7,585,218

19661118.200208.2.003 IV A 24.850.609.9-403.000 1

2 dr.Rismaini 4,826,957 241,348 4,585,609

19760111.200701.2.006 III D 36.299.269.5-403.000 2

3 dr.Bambang 5,171,739 258,587 4,913,152

19 3

4 Noli Haryono 2,920,512 146,026 2,774,486

19640327.199012.2.001 III D 69.732.771.0.403.000 4

5 Ni nyoman suardi 3,894,015 194,701 3,699,315

19701209.199002.2.001 III D 69.732.769.0-403.000 5

6 Kurniati 2,920,512 146,026 2,774,486

19680708.199103.2.006 III C 69.732.777.4-403.000 6

7 Indrawati 3,894,015 194,701 3,699,315

19720813.199203.2.003 III D 35.314.553.5-434.000 7

8 Siti Rogayah 4,705,269 235,263 4,470,005

19711215.199203.2.003 III D 73.554.417.3-403.000 8

9 Arif Irsiyyadi 4,056,266 202,813 3,853,453

19730411.199203.1.001 III C 73.544.521.5-412.000 9

10 Runi Khaerunisa 3,407,264 170,363 3,236,900

19790603.201001.2.006 III A 58.214.772.4-411.000 10

11 Dewi Komala 3,082,762 154,138 2,928,624

198101172008012002 III A 34.850.441.6-403.000 11
12 Lely Mauli 19750404.200501.2.011 III A 09.208.547.1-403.001 2,758,261 137,913 2,620,348 12

13 Kasuhaevi 2,433,760 121,688 2,312,072

198306012011012001 II D 34.850.441.6-403.000 13

14 Lusi Nurwianih 2,433,760 121,688 2,312,072

197904242011012003 II D 45.984.929.5-403.000 14

15 Ismawati Diah 2,433,760 0 2,433,760

198310012012112001 II D 73.072.571.0-403.000 15

16 Musdalifah 1,987,570 0 1,987,570

16

17 Retno Asri Fitriani 2,271,509 0 2,271,509

199203292015012001 II C 54.054.225.5-403.000 17

18 Pepen Komarudin 196702141990031005 2,890,090 144,504 2,745,585

PTT 69.049.147.7-404.000 18

19 drg taufik 5,029,770 251,488 4,778,281

1000673 PTT 72.128.677.1-016-000 19

20 Rama yanti 2,596,010 129,801 2,466,210

5000518 PTT 71.636.989.7-404.000 20

21 Yanti Prihatin 2,596,010 129,801 2,466,210

6 PTT 71.636.989.7-404.000 21
22 Ika 1,947,008 116,820 1,830,187
4000837 PTT 70.391.400.2-434.000 22

23 Lenny 454,302 27,258 427,044

Honor 23

24 Jaenudin 324,501 19,470 305,031

Honor 24

25 Entong Saputra 324,501 19,470 305,031

Honor 25

26 Yogi 324,501 19,470 305,031

Honor 26

27 Asep 324,501 19,470 305,031

Honor 27

78,932,910 4,541,375 74,391,535

Jumlah Jumlah

Terbilang : /// Tujuh Puluh Delapan Juta Sembilan Ratus Tiga Puluh Dua Ribu Sembilan Ratus Sepuluh Rupiah ///

Mengetahui
Kepala Puskesmas Jampang Yang membayarkan

dr Vera Linda C.B Siti Rogayah

NIP. 19661118.200208.2.003 NIP. 19711215.199203.2.003
3,683,512
122430

3,805,942

790466

4,596,408
Kode Program :16 Kode Kegiatan :0318 Kode Rekening :5.2.2.03.12

DAFTAR PENERIMAAN JASA PELAYANAN DANA KAPITASI JKN PUSKESMAS JAMPANG

SUSULAN BULAN : MEI 2018

No NAMA NIP GOL NPWP JUMLAH (Rp) POT.PAJAK PPH 21 JUMLAH DITERIMA (Rp) Tanda Tangan
1 2 3 4 5 6 7 8 9
1 dr,Vera Linda C.B 19661118.200208.2.003 IV A 24.850.609.9-403.000 142,911 21,437 121,474 1
2 dr.Rismaini 19760111.200701.2.006 III D 36.299.269.5-403.000 90,423 4,521 85,902 2
3 Noli Haryono 19640327.199012.2.001 III D 69.732.771.0.403.000 58,204 2,910 55,293 3

4 Ni nyoman suardi
19701209.199002.2.001 III D 69.732.769.0-403.000 60,802 3,040 57,762 4

5 Kurniati
19680708.199103.2.006 III C 69.732.777.4-403.000 50,408 2,520 47,888 5
6 Indrawati 19720813.199203.2.003 III D 35.314.553.5-434.000 65,479 9,822 55,657 6

7 Siti Rogayah
19711215.199203.2.003 III C 73.554.417.3-403.000 49,802 2,490 47,312 7

8 Arif Irsiyyadi
19730411.199203.1.001 III C 73.544.521.5-412.000 75,353 3,768 71,585 8

9 Runi Khaerunisa 72,754

19790603.201001.2.006 III A 58.214.772.4-411.000 3,638 69,117 9

10 Dewi Komala
198101172008012002 III A 34.850.441.6-403.000 46,316 2,316 44,000 10

11 Lely Mauli
19750404.200501.2.011 III A 09.208.547.1-403.001 36,810 1,841 34,970 11

12 Kasuhaevi
198306012011012001 II D 34.850.441.6-403.000 42,613 2,131 40,483 12

13 Lusi Nurwianih
197904242011012003 II D 45.984.929.5-403.000 11,974 0 11,974 13

14 Ismawati Diah
198310012012112001 II D 73.072.571.0-403.000 43,133 0 43,133 14

15 Retno Asri Fitriani 199203292015012000 II C 54.054.225.5-403.000 82,174 0 82,174 15

16 Pepen Komarudin 196702141990031005 III D 69.049.147.7-404.000 35,706 1,785 33,921 16

17 drg taufik
1000673 PTT 72.128.677.1-016.000 84,707 4,235 80,472 17

18 Rama yanti 37,287 1,864 35,422

5000518 PTT 73.554.417.3-403.000 18

19 Yanti Prihatin 6 PTT 71.636.989.7-404.000 32,371 1,619 30,753 19

20 Ika 29,881
4000837 PTT 70.391.400.2-434.000 1,793 28,088 20
21 Lenny
Honor 10,393 624 9,770 21

22 Jaenudin
Honor 4,980 299 4,681 22

23 Entong Saputra
Honor 4,980 299 4,681 23
24 Yogi Honor 4,980 299 4,681 24
25 Asep Honor 5,197 312 4,885 25

Jumlah Jumlah 1,179,640 73,561 1,106,079

Terbilang : /// Satu Juta Seratus Tujuh Puluh Sembilan Ribu Enam Ratus Empat Puluh Rupiah ///

Mengetahui
Kepala Puskesmas Jampang Yang membayarkan

dr Vera Linda C.B Siti Rogayah

NIP. 19661118.200208.2.003 NIP. 19711215.199203.2.003
 JASA PELAYANAN FKTP PUSKESMAS JAMPANG BULAN MARET 2017

Jmlh hari 26 Total Dana 56247600

BULAN : MARET 2017
Formulasi
VARIABEL Perhitungan
Persentase Pajak
Total Point Jumlah
No NAMA Kehadiran Kehadiran Jenis Rangkap Tanggung Penambah Sebelum PPH 21 potongan 7% yang di terima TANDA
(A) Masa Kerja ( G) diterima
Ketenagaan Tugas Adm Jawab Prog Pengurang (A X
(B) © (D) (E) (F) ( B+C+D+E+))/ PPh 21
XG TANGAN

1 dr,Vera Linda C.B 24 1.00 150 17.00 100.00 10.00 278.00 7,295,520 1,094,328 6,201,192 434,083 5,767,109

2 dr.Rismaini 24 0.92 150 14.00 10.00 174.92 4,388,662 219,433 4,169,229 291,846 3,877,383

3 Cucu Mariam 10 0.38 80 27.00 15.00 5.00 127.38 1,334,675 66,734 1,267,941 88,756 1,179,185

4 Noli Haryono 26 1.00 60 27.00 5.00 93.00 2,513,812 125,691 2,388,122 167,169 2,220,953

5 Ni nyoman suardi 26 1.00 80 27.00 10.00 118.00 3,196,913 159,846 3,037,068 212,595 2,824,473

6 Kurniati 26 1.00 60 26.00 5.00 92.00 2,486,488 124,324 2,362,164 165,351 2,196,812

7 Indrawati 25 0.96 80 25.00 5.00 110.96 2,890,043 144,502 2,745,541 192,188 2,553,353

8 Siti Rogayah 26 1.00 80 25.00 50.00 5.00 161.00 4,371,847 218,592 4,153,255 290,728 3,862,527

9 Arif Irsiyyadi 26 1.00 60 25.00 15.00 20.00 121.00 3,278,886 163,944 3,114,941 218,046 2,896,895

10 Runi Khaerunisa 26 1.00 80 8.00 5.00 94.00 2,541,136 127,057 2,414,079 168,986 2,245,094

11 Dewi Komala 25 0.96 60 15.00 5.00 80.96 2,101,850 105,092 1,996,757 139,773 1,856,984

12 Lely Mauli 24 0.92 60 12.00 15.00 87.92 2,194,331 109,717 2,084,615 145,923 1,938,692

13 Kasuhaevi 20 0.77 60 9.00 5.00 5 79.77 1,660,461 0 1,660,461 116,232 1,544,229

14 Ismawati Diah 26 1.00 60 8.00 10.00 5 84.00 2,267,896 0 2,267,896 158,753 2,109,143

15 Musdalfah 25 0.96 60 5.00 5.00 70.96 1,839,118 0 1,839,118 128,738 1,710,380

15 drg taufik 26 1.00 150 3.00 5.00 159.00 4,317,199 215,860 4,101,339 287,094 3,814,246

16 Rama yanti 26 1.00 60 8.00 5.00 10 84.00 2,267,896 113,395 2,154,501 150,815 2,003,686

17 Yanti Prihatin 26 1.00 60 12.00 10.00 83.00 2,240,572 112,029 2,128,543 148,998 1,979,545
18 Ika 26 1.00 60 0.00 5.00 66.00 1,776,063 88,803 1,687,260 118,108 1,569,152

19 Leny 26 1.00 25 0.00 0.00 -10 16.00 409,861 20,493 389,368 0 389,368

20 Deden A Mukti 26 1.00 25 0.00 0.00 -13 13.00 327,889 19,673 308,215 0 308,215

21 Jaenudin 26 1.00 25 0.00 0.00 -15 11.00 273,240 16,394 256,846 0 256,846

22 Entong Saputra 26 1.00 25 0.00 0.00 -15 11.00 273,240 16,394 256,846 0 256,846

2068.54 56,247,600 3,262,302 52,985,298 3,624,182 49,361,116

Jumlah
56,247,600 52,985,298
Mengetahui/Menyetujui
Kepala UPF Puskesmas Jampang Bendahara JKN UPF Puskesmas Jampang

( dr.Vera Linda C.B ) ( Siti Rogayah )

NIP 196611182002122003 NIP 197112151992032003
7,295,520 6,201,192 0

4,388,662 4,169,229 0

1,334,675 1,267,941 0

2,513,812 2,388,122 0

3,196,913 3,037,068 0

2,486,488 2,362,164 0

2,890,043 2,745,541 0

4,371,847 4,153,255 0

3,278,886 3,114,941 0

2,541,136 2,414,079 0

2,101,850 1,996,757 0

2,194,331 2,084,615 0

1,660,461 1,660,461 0

2,267,896 2,267,896 0

1,839,118 1,839,118 0

4,317,199 4,101,339 0

2,267,896 2,154,501 0

2,240,572 2,128,543 0
 1,776,063 1,687,260 0

409,861 389,368 0

327,889 308,215 0

273,240 256,846 0

273,240 256,846 0

56,247,600 52,985,298 0
0
 DAFTAR PENERIMAAN JASA PELAYANAN JKN
PUSKESMAS CIBINONG

BULAN : Nopember 2015

2,267,881
#VALUE!
 1,839,103
#VALUE!

#VALUE!
 NAMA -NAMA KARYAWAN FKTP PUSKEKESMAS

JKN BULAN JUNI 2018

NAMA NO REK BANK JP

NO
1 dr Vera Linda 0009021647100 BJB 7,000,000
2 dr Rismain 0003673561100 BJB 4,200,000
3 dr.Bambang BJB 4,500,000
3 Noli Haryono 0056859731101 BJB 2,500,000
4 NI Nyoman 0001938983100 BJB 3,400,000
5 Kurniati '0001938991100 BJB 2,500,000
6 Indrawati 0001939025100 BJB 3,400,000
7 Siti Rogayah 0002545810101 BJB 5,900,000
8 Arif Irssyadi 0056279318101 BJB 3,500,000
9 Runi Khaerunisa 0056279334100 BJB 3,000,000
10 Dewi Kumalasari 0006946836100 BJB 2,700,000
11 Lely Mauli 0001550489100 BJB 2,400,000
12 Kasuhaevi 0056288562100 BJB 2,100,000
13 Lusi Nurwiani 0035017331100 BJB 2,100,000
14 Ismawati Diah 0056434658100 BJB 2,200,000
15 Musdalifah BJB 0
15 Retno Asri F 0063280658100 BJB 2,100,000
16 Pepen Komarudin 0007204396101 BJB 2,500,000
17 drg Taufik 0071976750100 BJB 4,400,000
18 Ramayanti 0071975932100 BJB 2,200,000
19 Yanti Prihatini 0071975908100 BJB 2,400,000
20 Ika Herawati 0071976734100 BJB 1,800,000
Total Rp66,800,000

Mengetahui Rp66,800,000
Ka FKTP Puskesmas Jampang

dr.Vera Linda C.B

NIP:196611182002122003
Kode Program : 16. Kode Kegiatan : 0318 Kode Rek : 5.2.2.03.12
Kwitansi
Nomor : 037/spj /V/JKN/2018
Telah terima dari : Dana Kapitasi JKN Puskesmas Jampang
Uang sejumlah : Sebelas Juta Dua Ratus Dua Puluh Satu Ribu Delapan Ratus Rupiah

Untuk pembayaran : Pembayaran Jaspel JKN Bulan Maret 2018

Rp. 11,221,800 LUNAS DIBAYAR

Pot. Pajak = TGL BKU 16 Mei 2018
Cibinong , 16 Mei 2018
Mengetahui/Menyetujui Bendahara JKN Puskesmas Jampang Penerima
Kepala Puskesmas Jampang

dr.Vera Linda C.B Siti Rogayah Siti Rogayah

NIP:196611182002122003 NIP.197112151992032003 NIP:197112151992032003

Kode Program : 16. Kode Kegiatan : 0318 Kode Rek : 5.2.2.03.12

Kwitansi
Nomor : 019 /spj /III/JKN/2018
Telah terima dari : Dana Kapitasi JKN Puskesmas Jampang
Uang sejumlah : Enam Ratus Sembilan Puluh Sembilan Ribu Rupiah

Untuk pembayaran : Pembayaran Jaspel Susulan Bulan Januari 2018

Rp. 699,000 LUNAS DIBAYAR

Pot. Pajak = TGL BKU 16 Mei 2018
Cibinong , 16 Mei 2018
Mengetahui/Menyetujui Bendahara JKN Puskesmas Jampang Penerima
Kepala Puskesmas Jampang

dr.Vera Linda C.B Siti Rogayah Siti Rogayah

NIP:196611182002122003 NIP.197112151992032003 NIP:197112151992032003
 8,114,501 1,217,175 6,897,326 72,653 10,898 61,755 8,187,154 1,228,073 6,959,081
6,196,528 309,826 5,886,702 55,542 2,777 52,765 6,252,070 312,603 5,939,466
3,363,829 168,191 3,195,638 31,254 1,563 29,692 3,395,084 169,754 3,225,330
4,610,512 230,526 4,379,986 32,786 1,639 31,147 4,643,298 232,165 4,411,133
3,223,670 161,183 3,062,486 33,673 1,684 31,990 3,257,343 162,867 3,094,476
4,426,091 221,305 4,204,787 41,027 6,154 34,873 4,467,119 227,459 4,239,660
5,348,194 267,410 5,080,784 38,947 1,947 37,000 5,387,141 269,357 5,117,784
3,835,946 191,797 3,644,149 47,898 2,395 45,503 3,883,843 194,192 3,689,651
3,872,830 193,641 3,679,188 42,576 2,129 40,447 3,915,406 195,770 3,719,635
3,503,989 175,199 3,328,790 34,061 1,703 32,357 3,538,050 176,902 3,361,147
2,382,713 119,136 2,263,577 24,191 1,210 22,981 2,406,903 120,345 2,286,558
2,766,307 138,315 2,627,992 22,062 1,103 20,959 2,788,369 139,418 2,648,951
- 0 0 26,707 1,335 25,371 26,707 1,335 25,371
2,832,698 0 2,832,698 26,319 0 26,319 2,859,018 0 2,859,018
2,766,307 0 2,766,307 57,493 0 57,493 2,823,800 0 2,823,800
2,382,713 119,136 2,263,577 26,078 1,304 24,774 2,408,790 120,440 2,288,351
5,717,035 285,852 5,431,183 61,154 3,058 58,096 5,778,189 288,909 5,489,279
2,832,698 141,635 2,691,064 27,868 1,393 26,474 2,860,566 143,028 2,717,538
2,950,728 147,536 2,803,191 23,223 1,161 22,062 2,973,951 148,698 2,825,253
2,213,046 132,783 2,080,263 23,223 1,393 21,830 2,236,269 134,176 2,102,093
737,682 44,261 693,421 9,676 581 9,096 747,358 44,841 702,517
368,841 22,130 346,710 9,676 581 9,096 378,517 22,711 355,806
368,841 22,130 346,710 9,676 581 9,096 378,517 22,711 355,806
368,841 22,130 346,710 9,676 581 9,096
368,841 22,130 346,710 787440 47168.67 740271.3 378,517 22,711 355,806
378,517
75553380 4353430 71199950.28
 7,117,032 1,067,555 6,049,477 81,937 12,291 69,647 7,198,969 1,079,845 6,119,124
4,860,961 243,048 4,617,913 47,856 2,393 45,463 4,908,817 245,441 4,663,376
2,835,560 141,778 2,693,782 33,371 1,669 31,702 2,868,931 143,447 2,725,485
3,510,694 175,535 3,335,159 34,861 1,743 33,118 3,545,554 177,278 3,368,277
2,835,560 141,778 2,693,782 27,790 1,389 26,400 2,863,350 143,168 2,720,183
3,510,694 175,535 3,335,159 37,542 5,631 31,911 3,548,236 181,166 3,367,070
3,915,774 195,789 3,719,985 34,265 1,713 32,551 3,950,039 197,502 3,752,537
3,645,721 182,286 3,463,435 43,203 2,160 41,043 3,688,924 184,446 3,504,478 2,914,045 35,937
2,970,587 148,529 2,822,058 41,714 2,086 39,628 3,012,301 150,615 2,861,686 762,960 7,682
2,835,560 141,778 2,693,782 27,710 1,385 26,324 2,863,270 143,164 2,720,107 3,677,005 43,619
2,565,507 128,275 2,437,232 25,326 1,266 24,060 2,590,833 129,542 2,461,291
2,104,166 105,208 1,998,958 20,673 1,034 19,640 2,124,839 106,242 2,018,597 2,949,982
1,339,015 66,951 1,272,064 23,538 1,177 22,361 1,362,553 68,128 1,294,425 770,642 3,720,624
2,070,409 0 2,070,409 22,828 0 22,828 2,093,237 0 2,093,237 3,720,624
2,160,427 0 2,160,427 49,162 0 49,162 2,209,589 0 2,209,589
2,362,967 118,148 2,244,819 24,455 1,223 23,232 2,387,422 119,371 2,268,051
4,590,907 229,545 4,361,362 48,566 2,428 46,138 4,639,474 231,974 4,407,500
2,295,454 114,773 2,180,681 23,493 1,175 22,318 2,318,946 115,947 2,202,999
2,295,454 114,773 2,180,681 18,622 931 17,691 2,314,076 115,704 2,198,372
1,755,347 105,321 1,650,026 17,190 1,031 16,158 1,772,537 106,352 1,666,184
540,107 32,406 507,700 5,959 358 5,602 546,066 32,764 513,302
270,053 16,203 253,850 2,980 179 2,801 273,033 16,382 256,651
270,053 16,203 253,850 2,980 179 2,801 273,033 16,382 256,651
259,791 15,587 244,204 2,980 179 2,801 262,771 15,766 247,005
62,917,800 3,677,005 59,240,795 699,000 43,619 655,381 63,616,800 3,720,624 59,896,176

63,616,800
3,720,624
59,896,176