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 SEPTEMBER 2017

Jmlh hari 23 Total Dana 56550720

BULAN : SEPTEMBER 2017

VARIABEL Formulasi Perhitungan

Persentase Total Pajak
7% YG DI TERIMA
No NAMA Kehadiran Kehadiran Jenis Rangkap Tanggung Penambah Point Sebelum PPH 21 Jumlah diterima TANDA
(A) Ketenagaan Masa Kerja 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 23 1.00 150 17.00 100.00 10.00 267.00 7,229,235 1,084,385 6,144,849 430,139 5,714,710
1

2 dr.Rismaini 23 1.00 150 14.00 10.00 174.00 4,711,187 235,559 4,475,627 313,294 4,162,333
2

3 Noli Haryono 23 1.00 60 27.00 5.00 92.00 2,490,972 124,549 2,366,424 165,650 2,200,774
3

4 Ni nyoman suardi 23 1.00 80 27.00 10.00 117.00 3,167,867 158,393 3,009,474 210,663 2,798,810
4

5 Kurniati 23 1.00 60 26.00 5.00 91.00 2,463,896 123,195 2,340,702 163,849 2,176,853
5

6 Indrawati 23 1.00 80 25.00 10.00 115.00 3,113,715 155,686 2,958,030 207,062 2,750,967
6

7 Siti Rogayah 23 1.00 80 25.00 50.00 5.00 160.00 4,332,126 216,606 4,115,519 288,086 3,827,433
7

8 Arif Irsiyyadi 23 1.00 60 25.00 30.00 15.00 130.00 3,519,852 175,993 3,343,859 234,070 3,109,789
8

9 Runi Khaerunisa 23 1.00 80 8.00 5.00 93.00 2,518,048 125,902 2,392,146 167,450 2,224,695
9

10 Dewi Komala 23 1.00 80 15.00 5.00 100.00 2,707,579 135,379 2,572,200 180,054 2,392,146
10

11 Lely Mauli 21 0.91 60 12.00 10.00 74.87 2,027,152 101,358 1,925,795 134,806 1,790,989
11
12 Kasuhaevi 18 0.78 60 9.00 10.00 61.83 1,673,990 0 1,673,990 117,179 1,556,811 12

13 Lusi Nurwiyanih 23 1.00 60 9.00 5.00 74.00 2,003,608 0 2,003,608 140,253 1,863,356
13

14 Ismawati Diah 0 - 60 8.00 10.00 0.00 - 0 0 0 0

14

15 Retno Asri Fitriani 23 1.00 60 2.00 5.00 67.00 1,814,078 0 1,814,078 126,985 1,687,092
15

16 Pepen Komarudin 14 0.61 50 27.00 5.00 49.91 1,351,435 67,572 1,283,863 89,870 1,193,993
16

17 drg taufik 23 1.00 150 9.00 5.00 164.00 4,440,429 222,021 4,218,407 295,289 3,923,119
17

18 Rama yanti 23 1.00 60 12.00 5.00 77.00 2,084,835 104,242 1,980,594 138,642 1,841,952
18
19 Yanti Prihatin 23 1.00 60 1.00 5.00 66.00 1,787,002 89,350 1,697,652 118,836 1,578,816
19

20 Ika 23 1.00 60 0.00 0.00 60.00 1,624,547 97,473 1,527,074 106,895 1,420,179
20

21 Leny 23 1.00 25 0.00 0.00 -5 20.00 541,516 32,491 509,025 0 509,025

21

22 Deden A Mukti 23 1.00 25 0.00 0.00 -10 15.00 406,137 24,368 381,769 0 381,769
22

23 Jaenudin 23 1.00 25 0.00 0.00 -5 10.00 270,758 16,245 254,512 0 254,512

23 Entong Saputra 23 1.00 25 0.00 0.00 -5 10.00 270,758 16,245 254,512 0 254,512

Jumlah 2088.61 56,550,720 3,307,013 53,243,707 3,727,060 49,516,648

56,550,720
Mengetahui/Menyetujui
Kepala UPF Puskesmas Jampang Bendahara JKN UPF Puskesmas Jampang

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

NIP 196611182002122003 NIP 197112151992032003

1,399,818
 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 AGUSTUS 2017
Jmlh hari 25 Total Dana 669990
BULAN : susulan Agustus 2017
Formulasi
VARIABEL
Persentas Perhitungan Pajak
Kehadira e Total
No NAMA Penamba Point Sebelum PPH 21 Jumlah diterima TANDA
n Kehadiran Jenis Rangkap Tanggung
Ketenaga Masa Kerja
h ( G)
(A) Tugas Adm Jawab Prog Penguran (A X ( B+C+D+E+))/
an (B) © (D) (E) PPh 21
g (F) XG TANGAN

1 dr,Vera Linda C.B 25 1.00 150 17.00 100.00 10.00 267.00 83,163 12,474 70,689
1

2 dr.Rismaini 23 0.92 150 14.00 10.00 150.88 46,995 2,350 44,645

2

3 Noli Haryono 26 1.04 60 27.00 15.00 5.00 106.08 33,041 1,652 31,389
3

4 Ni nyoman suardi 26 1.04 80 27.00 5.00 111.28 34,661 1,733 32,928

4

5 Kurniati 26 1.04 60 27.00 10.00 90.48 28,182 1,409 26,773

5

6 Indrawati 26 1.04 80 26.00 5.00 110.24 34,337 5,151 29,186

6

7 Siti Rogayah 23 0.92 80 25.00 10.00 96.60 30,088 1,504 28,584

7

8 Arif Irsiyyadi 26 1.04 60 25.00 50.00 5.00 140.40 43,731 2,187 41,544
8

9 Runi Khaerunisa 26 1.04 80 25.00 15.00 20.00 124.80 38,872 1,944 36,928
9

10 Dewi Komala 26 1.04 80 8.00 5.00 91.52 28,506 1,425 27,081

10

11 Lely Mauli 26 1.04 60 15.00 10.00 78.00 24,295 1,215 23,080

11

12 Kasuhaevi 22 0.88 60 12.00 15.00 63.36 19,735 0 19,735

12

13 Lusi Nurwianih 22 0.88 60 9.00 5.00 60.72 18,913 0 18,913

13

14 Ismawati Diah 13 0.52 60 8.00 10.00 35.36 11,014 0 11,014

14

15 Retno Asri Fitriani 26 1.04 150 5.00 5.00 161.20 50,209 0 50,209
15

16 drg taufik 26 1.04 150 3.00 10.00 159.12 49,562 2,478 47,083
16

17 Rama yanti 26 1.04 60 8.00 10.00 70.72 22,027 1,101 20,926

17

18 Yanti Prihatin 26 1.04 60 12.00 10.00 74.88 23,323 1,166 22,157

18
19 Ika 26 1.04 60 0.00 0.00 62.40 19,436 972 18,464
19

20 Leny 18 0.72 25 0.00 0.00 18.00 5,607 336 5,270

20

21 Deden A Mukti 26 1.04 25 0.00 0.00 26.00 8,098 486 7,612

21

22 Jaenudin 26 1.04 25 0.00 0.00 26.00 8,098 486 7,612

22

23 Entong Saputra 26 1.04 25 0.00 0.00 26.00 8,098 486 7,612

23

2151.04 669,990 40,555 629,435

Jumlah
669,990
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 : AGUSTUS 2017

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 6,825,748 1,023,862 5,801,886

19661118.200208.2.003 IV A 24.850.609.9-403.000 1

2 dr.Rismaini 4,092,381 204,619 3,887,762

19760111.200701.2.006 III D 36.299.269.5-403.000 2

3 Noli Haryono 2,578,957 128,948 2,450,009

19640327.199012.2.001 III D 69.732.771.0.403.000 3

4 Ni nyoman suardi 3,110,700 155,535 2,955,165

19701209.199002.2.001 III D 69.732.769.0-403.000 4

5 Kurniati 2,419,434 120,972 2,298,462

19680708.199103.2.006 III C 69.732.777.4-403.000 5

6 Indrawati 3,057,526 152,876 2,904,650

19720813.199203.2.003 III D 35.314.553.5-434.000 6

7 Siti Rogayah 3,763,109 188,155 3,574,954

19711215.199203.2.003 III C 73.554.417.3-403.000 7

8 Arif Irsiyyadi 3,589,270 179,463 3,409,806

19730411.199203.1.001 III C 73.544.521.5-412.000 8

9 Runi Khaerunisa 2,605,544 130,277 2,475,267

19790603.201001.2.006 III A 58.214.772.4-411.000 9

10 Dewi Komala 2,658,718 132,936 2,525,782

198101172008012002 III A 34.850.441.6-403.000 10

11 Lely Mauli 2,446,021 122,301 2,323,720

19750404.200501.2.011 III A 09.208.547.1-403.001 11

12 Kasuhaevi 1,777,251 0 1,777,251

198306012011012001 II D 34.850.441.6-403.000 12

13 Lusi Nurwianih 1,664,767 0 1,664,767

197904242011012003 II D 45.984.929.5-403.000 13

14 Ismawati Diah 903,964 0 903,964

198310012012112001 II C 73.072.571.0-403.000 14

15 Retno Asri Fitriani 2,047,213 0 2,047,213

199203292015012001 II C 54.054.225.5-403.000 15

16 drg taufik 4,200,775 210,039 3,990,736

1000673 PTT 72.128.677.1-016-000 16

17 Rama yanti 2,233,323 111,666 2,121,657

5000518 PTT 71.636.989.7-404.000 17

18 Yanti Prihatin 2,180,149 109,007 2,071,142

6 PTT 71.636.989.7-404.000 18
19 Ika 1,754,754 87,738 1,667,016
4000837 PTT 70.391.400.2-434.000 19

20 Lenny 531,744 31,905 499,839

Honor 20

21 Deden A Mukti 398,808 23,928 374,879

Honor 21

22 Jaenudin 265,872 15,952 249,920

Honor 22

23 Entong Saputra 265,872 15,952 249,920

23

55,371,900 3,146,133 52,225,767

Jumlah Jumlah

Terbilang : /// Lima Puluh Lima Juta Tiga Ratus Tujuh Puluh Satu Ribu Sembilan Ratus Rupiah //

Mengetahui
Kepala Puskesmas Jampang Yang membayarkan

dr Vera Linda C.B Siti Rogayah

NIP. 19661118.200208.2.003 NIP. 19711215.199203.2.003
Kode Program :16 Kode Kegiatan :0318 Kode Rekening :5.2.2.03.12

DAFTAR PENERIMAAN JASA PELAYANAN DANA KAPITASI JKN PUSKESMAS JAMPANG

SUSULAN BULAN : JULI 2017

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 53,540 8,031 45,509 1
2 dr.Rismaini 19760111.200701.2.006 III D 36.299.269.5-403.000 33,671 1,684 31,987 2
3 Noli Haryono 19640327.199012.2.001 III D 69.732.771.0.403.000 20,800 1,040 19,760 3
4 Ni nyoman suardi 19701209.199002.2.001 III D 69.732.769.0-403.000 21,763 1,088 20,674 4
5 Kurniati 19680708.199103.2.006 III C 69.732.777.4-403.000 18,874 944 17,930 5
6 Indrawati 19720813.199203.2.003 III D 35.314.553.5-434.000 21,570 3,236 18,335 6
7 Siti Rogayah 19711215.199203.2.003 III C 73.554.417.3-403.000 22,340 1,117 21,223 7
8 Arif Irsiyyadi 19730411.199203.1.001 III C 73.544.521.5-412.000 27,155 1,358 25,797 8
9 Runi Khaerunisa 19790603.201001.2.006 III A 58.214.772.4-411.000 27,155 1,358 25,797 9

10 Dewi Komala
198101172008012002 III A 34.850.441.6-403.000 18,103 905 17,198 10
11 Lely Mauli 19750404.200501.2.011 III A 09.208.547.1-403.001 16,426 821 15,605 11
12 Kasuhaevi 198306012011012001 II D 34.850.441.6-403.000 16,948 0 16,948 12
13 Lusi Nurwianih 197904242011012003 II D 45.984.929.5-403.000 14,412 0 14,412 13
13 Ismawati Diah 198310012012112001 II D 73.072.571.0-403.000 15,215 0 15,215 14

15 Retno Asri Fitriani 199203292015012000 II C 54.054.225.5-403.000 31,007 0 31,007 15

16 drg taufik 1000673 PTT 72.128.677.1-016.000 31,585 1,579 30,005 16

17 Rama yanti
5000518 PTT 73.554.417.3-403.000 15,215 761 14,454 17

18 Yanti Prihatin 15,985

6 PTT 71.636.989.7-404.000 799 15,186 18
19 Ika 11,748
4000837 PTT 70.391.400.2-434.000 587 11,161 19

20 Lenny 5,007
Honor 300 4,707 20

21 Deden A Mukti
Honor 5,007 300 4,707 21

22 Jaenudin
Honor 5,007 300 4,707 22

23 Entong Saputra
Honor 5,007 300 4,707 23

453,540 26,509 427,031

Jumlah Jumlah 453,540 26,509 427,031

Terbilang : /// Empat Ratus Lima Puluh Tiga Ribu Lima 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 AGUSTUS 2017

NAMA NO REK BANK JP

NO
1 dr Vera Linda 2552003147 Bank Panin Rp5,000,000
2 dr Rismain 0003673561100 BJB Rp3,500,000
3 Noli Haryono 0056859731101 BJB 2,100,000
4 NI Nyoman 0001938983100 BJB 2,700,000
5 Kurniati '0001938991100 BJB 2,100,000
6 Indrawati 0001939025100 BJB 2,600,000
7 Siti Rogayah 0002545810101 BJB 3,200,000
8 Arif Irssyadi 0056279318001 BJB 3,100,000
9 Runi Khaerunisa 0056279334100 BJB 2,200,000
10 Dewi Kumalasari 0006946836100 BJB 2,300,000
11 Lely Mauli 0001550489100 BJB 2,100,000
12 Kasuhaevi 0056288562100 BJB 1,600,000
13 Lusi Nurwiani 0035017331100 BJB 1,500,000
14 Ismawati Diah 0056434658100 BJB 1,600,000
15 Retno Asri F 0063280658100 BJB 1,600,000
16 drg Taufik 0071976750100 BJB 3,600,000
17 Ramayanti 0071975932100 BJB 1,900,000
18 Yanti Prihatini 0071975908100 BJB 1,800,000
19 Ika Herawati 0071976734100 BJB 1,500,000
Total Rp46,000,000

Mengetahui
Ka FKTP Puskesmas Jampang

dr.Vera Linda C.B

NIP:196611182002122003
Tarik Uang 153,160,256
Jaspel di Trasfer JP 46,000,000
Trasfer BJB Cv Tugu sadewa 57,643,095
pajak 6,729,905
Jumlah 110,373,000

Tunai 42,787,256

NO Rek C.V Dadewa 7762975001

Gordyn Puskesmas Jampang
Kode Program : 16. Kode Kegiatan : 0318 Kode Rek : 5.2.2.03.12
Kwitansi
Nomor : 033 /spj /VI /2017
Telah terima dari : Dana Kapitasi JKN FKTP Puskesmas Jampang

Uang sejumlah : Lima Puluh Tiga Juta Enam Ratus Delapan Puluh Sembilan Ribu Sembilan Ratus Dua Puluh Rupiah

Untuk pembayaran : Pembayaran Jaspel JKN Bulan Mei 2017

Rp. 53,689,920 LUNAS DIBAYAR

Pot. Pajak = TGL BKU 19 Juni 2017 Cibinong , 13 Juni 2017

Mengetahui/Menyetujui Bendahara JKN Puskesmas Jampang Penerima

Kepala FKTP 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 : 034 /spj /VI /2017
Telah terima dari : Dana Kapitasi JKN FKTP Puskesmas Jampang

Uang sejumlah : Sembilan Ratus Sembilan Belas Ribu Empat Ratus Sepuluh Rupiah

Untuk pembayaran : Pembayaran Jaspel Susulan Bulan April 2017

Rp. 919,410 LUNAS DIBAYAR

Pot. Pajak = TGL BKU 19 Juni 2017 Cibinong , 13 Juni 2017

Mengetahui/Menyetujui Bendahara JKN Puskesmas Jampang Penerima

Kepala FKTP Puskesmas Jampang

dr.Vera Linda C.B Siti Rogayah Siti Rogayah

NIP:196611182002122003 NIP.197112151992032003 NIP:197112151992032003
 6,825,748 1,023,862 5,801,886 53,540 8,031 45,509 6,879,288 1,031,893 5,847,395
4,092,381 204,619 3,887,762 33,671 1,684 31,987 4,126,052 206,303 3,919,750
2,578,957 128,948 2,450,009 20,800 1,040 19,760 2,599,756 129,988 2,469,769
3,110,700 155,535 2,955,165 21,763 1,088 20,674 3,132,463 156,623 2,975,840
2,419,434 120,972 2,298,462 18,874 944 17,930 2,438,307 121,915 2,316,392
3,057,526 152,876 2,904,650 21,570 3,236 18,335 3,079,096 156,112 2,922,984
3,763,109 188,155 3,574,954 22,340 1,117 21,223 3,785,449 189,272 3,596,177
3,589,270 179,463 3,409,806 27,155 1,358 25,797 3,616,425 180,821 3,435,604
2,605,544 130,277 2,475,267 27,155 1,358 25,797 2,632,699 131,635 2,501,064
2,658,718 132,936 2,525,782 18,103 905 17,198 2,676,822 133,841 2,542,981
2,446,021 122,301 2,323,720 16,426 821 15,605 2,462,447 123,122 2,339,325
1,777,251 0 1,777,251 16,948 0 16,948 1,794,199 0 1,794,199
1,664,767 0 1,664,767 14,412 0 14,412 1,679,179 0 1,679,179
903,964 0 903,964 15,215 0 15,215 919,179 0 919,179
2,047,213 0 2,047,213 31,007 0 31,007 2,078,220 0 2,078,220
4,200,775 210,039 3,990,736 31,585 1,579 30,005 4,232,360 211,618 4,020,742
2,233,323 111,666 2,121,657 15,215 761 14,454 2,248,538 112,427 2,136,111
2,180,149 109,007 2,071,142 15,985 799 15,186 2,196,134 109,807 2,086,327
1,754,754 87,738 1,667,016 11,748 587 11,161 1,766,502 88,325 1,678,177
531,744 31,905 499,839 5,007 300 4,707 536,751 32,205 504,546
398,808 23,928 374,879 5,007 300 4,707 403,815 24,229 379,586
265,872 15,952 249,920 5,007 300 4,707 270,879 16,253 254,626
265,872 15,952 249,920 5,007 300 4,707 270,879 16,253 254,626
- 0 453,540 26,509 427,031
55,371,900 3,146,133 52,225,767 55,825,440 3,172,642 52,652,798
55,825,440