DAFTAR PENERIMAAN

JASA PELAYANAN KAPITASI JAMINAN KESEHATAN NASIONAL (JKN)

UPTD PUSKESMAS PEMBANGUNAN
BULAN JANUARI 2015
TAHUN ANGGARAN 2015
Rp 39,000,000
Rp 40,000,000
VARIABEL VARIABEL DAERAH PERHITUNGAN
POINT
KEHADIRAN POIN POIN PER PER ORANG

KEPEGAWAIAN
KETENAGAAN

MASA KERJA
ORANG JMLH ORG

JABATAN

KINERJA
No. PETUGAS PUSKESMAS NIP GOL JABATAN NPWP PERHARI VARIABEL PERHARI

EFEKTIF

STATUS
TDK HADIR
KETENAG DAERAH VAR (K6)-(K8 x K9) +
AAN DAERAH (K7-K8)+(K13)-

1 BL
(K8XK14)

9 14
13
1 2 3 4 5 6 7 8 10 11 12 15
(6/7) (10+11+12)
(13/7)
1 dr.Hj.Sri Cahyatiningsih 196810062002122001 IV.b Kepala Puskesmas 69.460.927.2-443.000 150 25 1 30 6.00 40 40 40 120 4.80 313.20
2 Lenia Ratna Susanti 196705131989022006 III.c Ka.Sub.Bag Tata Usaha 15 25 0 30 1.80 40 40 20 100 4.00 170.00
3 Yanyan Supriatna,AMD,S.IP 196902172007011010 III.a Bendahara JKN 70.629.580.5-443.000 40 25 0 30 2.80 40 40 20 100 4.00 195.00
4 dr.Hj.Sisca Risya Fujiarti 198001012010012008 III.c dr.Fungsional 79.506.558.0-443.000 150 25 1 0 6.00 40 15 20 75 3.00 240.00
5 dr.Khania Puspitasari,MARS 197803012007012008 III.d dr.Fungsional Gigi 66.788.118.9-443.000 150 25 2 0 6.00 40 15 15 70 2.80 225.40
6 Momoh Rohanah, AMK 196407311987032004 III.d Pel.Perawat 78.737.531.0-443.000 40 25 1 0 1.60 40 40 5 85 3.40 144.00
7 Hj.Iis Susilawati, AMK 196712261988032003 III.d Pel.Perawat 25.682.985.4-443.000 40 25 1 0 1.60 40 40 5 85 3.40 144.00
8 Hj.Neneng Kurniasih, Am.Keb 195906191981072001 III.d Bidan Koordinator 87.705.648.1-443.000 40 25 1 0 1.60 40 40 5 85 3.40 144.00
9 Wartinah, AMK 196704211989022001 III.d Pel.Perawat 26.012.366.6-443.000 40 25 1 0 1.60 40 40 5 85 3.40 144.00
10 Hj.Hasanah, S.Kep 196809281995032003 III.d Pel.Perawat 60 25 0 0 2.40 40 40 5 85 3.40 170.00
11 Hj.Elis Supyeni, Am.Keb 196712011989032003 III.d Bidan Fungsional 40 25 4 0 1.60 40 40 5 85 3.40 126.00
12 Euis Sukmawati, M.Kes 197501301995032001 III.d Sanitarian 40 25 1 0 1.60 40 35 5 80 3.20 139.20
13 Tati Sudaryati, AMKG 197206251994022006 III.c Pel.Perawat Gigi 66.803.020.8-443.000 40 25 2 0 1.60 40 35 5 80 3.20 133.40
14 Hj.Lina Zenab,SP 197204161992022001 III.c TPG 60 25 3 0 2.40 40 35 5 80 3.20 145.20
15 Mietta Pursitawati,S.Si.Apt 197711152006042005 III.b Apoteker 25.312.825.0-443.000 50 25 0 0 2.00 40 15 5 60 2.40 135.00
16 Yoseph Ferry, AMK 197803162006041016 III.b Pel.Perawat 24.326.102.1-443.000 40 25 2 0 1.60 40 15 5 60 2.40 115.00
17 Wheni Puspitawati, AMK 198305172005012006 III.b Pel.Perawat 40 25 2 0 1.60 40 15 5 60 2.40 115.00
18 Gungun Nurdiansyah,S.Kep 198209272010011018 III.a Pel.Perawat 60 25 0 0 2.40 40 15 5 60 2.40 145.00
19 Iis Fatimah,SKM 197904162006042000 II.d Analis / Lab 79.970.844.1-443.000 40 25 1 0 1.60 40 15 5 60 2.40 120.00
20 Hj.Husnul Khotimah,S.ST 197501242007012006 II.d Bidan Fungsional 78.737.497.4-443.000 40 25 1 0 1.58 40 35 0 75 3.00 133.93
21 Hj.Rini Lestari, Am.Keb, SE 197509202007012009 II.d Bend.Penerima 40 25 14 0 1.58 40 35 10 85 3.40 65.78
22 Ema Asgaritta,S.ST 197710282008012008 II.d Bidan Fungsional 89.873.620.2-443.000 40 25 1 0 1.58 40 35 0 75 3.00 133.93
23 Ratna Nurhasanah, AMK 198503242011012002 II.c Pel.Perawat 40 25 1 0 1.58 40 10 5 55 2.20 114.73
24 Yeni Rella 196110232007012001 II.b Pel.Administrasi 25.699.804.8-443.000 15 25 2 0 0.60 40 40 5 85 3.40 115.00
25 Sipa Nurasvia, AMKG TKK Pel.Perawat Gigi 25 25 0 0 1.00 10 10 0 20 0.80 70.00
26 Ricka Rikmasari, AMK TKK Pel.Perawat 40 25 9 0 1.60 10 10 0 20 0.80 54.40
27 Dewi Yulianti, AMK TKK Pel.Perawat 40 25 0 0 1.60 10 10 5 25 1.00 90.00
28 Nina Widianty TKK Pel.Perawat 71.472.994.4-443.000 25 25 0 0 1.00 10 10 0 20 0.80 70.00
29 Niki Sesbania TKK Pel.Perawat 25 25 0 0 1.00 10 10 0 20 0.80 70.00
30 Irma Nurma Diana, AM.Keb PTT Bides Sukakarya 57.951.523.0-443.000 40 25 1 0 1.60 15 15 5 35 1.40 96.00
31 Rina Kurnia Aprianti, Am.Keb PTT Bides Sukagalih 40 25 3 0 1.60 15 15 5 35 1.40 88.00
32 Dian Pramesti, Am.Keb PTT Bides Sukajaya 57.951.522.2-443.000 40 25 4 0 1.60 15 15 5 35 1.40 84.00
33 Elis Supriyanti, AMKG TKS Pel.Perawat Gigi 25 25 6 0 1.00 5 5 0 10 0.40 45.60
34 M Faisal Ali, S.IP TKS Pel.Administrasi 15 25 3 0 0.60 5 5 0 10 0.40 44.00
35 Fatmawati, Am.Keb TKS Bides Mekargalih 40 25 2 0 1.60 5 5 5 15 0.60 73.60
36 Hasan Alvian, AMK TKS Pel.Perawat 40 25 1 0 1.60 5 5 0 10 0.40 72.00
37 Risna D Yulianti, S.ST TKS Pel.Bidan 36.646.908.8-443.000 40 25 1 0 1.60 5 5 0 10 0.40 72.00
38 Asep Rizal Romdhoni,AMK TKS Pel.Perawat 40 25 10 0 1.60 5 5 0 10 0.40 45.00
39 H. Subagja Eska Hidayat TKS Operator JKN 35.135.706.6-443.000 15 25 2 0 0.60 5 5 10 20 0.80 55.20
40 Neneng Wulan TKS Pel.Harian Obat 71.473.004.1-443.000 25 25 0 0 1.00 5 5 0 10 0.40 60.00
41 Dadan Nurdiansyah,ST TKS Pel.Administrasi 71.466.360.6-443.000 15 25 2 0 0.60 5 5 0 10 0.40 46.00

Magang Pel.Perawat /
42 Tira Febrianti DJ, AMK 40 25 0 0 1.60 5 5 0 10 0.40 75.00
Operator JKN
43 Moch Rifan Sugandi Magang Pel.Harian Lab 25 25 1 0 1.00 5 5 0 10 0.40 57.60
44 Empon Rukmini TKS Cleaning Service 15 25 0 0 0.60 5 5 0 10 0.40 50.00

JUMLAH TOTAL 4945.17

Kepala Puskesmas / FKTP Puskesmas Pembangunan

Kecamatan Tarogong Kidul Kabupaten Garut Bend
 dr.HJ.SRI CAHYATININGSIH
NIP. 19681006 200212 2 001
 JASPEL
DITERIMA
JUMLAH
PAJAK PPh
Psl 21 JASPEL TANDA TANGAN
(K11)/TOTAL DITERIMA
POIN X TOTAL
JASPEL

16 17 18 19

2,470,045 123,502 2,346,543 1

1,340,701 67,035 1,273,666 2
1,537,863 76,893 1,460,970 3
1,892,755 94,638 1,798,117 4
1,777,612 88,881 1,688,732 5
1,135,653 56,783 1,078,870 6
1,135,653 56,783 1,078,870 7
1,135,653 56,783 1,078,870 8
1,135,653 56,783 1,078,870 9
1,340,701 67,035 1,273,666 10
993,696 49,685 944,011 11
1,097,798 54,890 1,042,908 12
1,052,056 52,603 999,453 13
1,145,117 57,256 1,087,861 14
1,064,675 53,234 1,011,441 15
906,945 45,347 861,598 16
906,945 45,347 861,598 17
 1,143,539 57,177 1,086,362 18
946,377 - 946,377 19
1,056,233 - 1,056,233 20
518,807 - 518,807 21
1,056,233 - 1,056,233 22
904,812 - 904,812 24
906,945 - 906,945 25
552,053 27,603 524,451 27
429,024 21,451 407,573 28
709,783 35,489 674,294 29
552,053 27,603 524,451 30
552,053 27,603 524,451 31
757,102 37,855 719,247 32
694,010 34,701 659,310 33
662,464 33,123 629,341 34
359,623 17,981 341,642 35
347,005 17,350 329,655 36
580,445 29,022 551,423 37
567,826 28,391 539,435 38
567,826 28,391 539,435 39
354,892 17,745 337,147 40
435,334 21,767 413,567 41
473,189 23,659 449,529 42
362,778 18,139 344,639 43

591,486 29,574 561,912 44

454,261 22,713 431,548 45

404,435 20,222 384,213 46

40,000,000 1,681,035 38,368,015

Garut, 29 Maret 2015

Bendahara JKN FKTP Puskesmas Pembangunan
YANYAN SUPRIATNA, AMD,S.IP
NIP. 19690217 200701 1 010
 DAFTAR PENERIMAAN
JASA PELAYANAN KAPITASI JAMINAN KESEHATAN NASIONAL (JKN)
UPTD PUSKESMAS PEMBANGUNAN
BULAN FEBRUARI 2015
TAHUN ANGGARAN 2015
Rp 50,000,000
PERHITUNGAN
VARIABEL VARIABEL DAERAH
POIN POIN PER POINT PER

KETENAGAAN
KEHADIRAN

KEPEGAWAIA

MASA KERJA
ORANG JMLH ORG ORANG

JABATAN

KINERJA
No. PETUGAS PUSKESMAS NIP GOL JABATAN NPWP PERHARI VARIABEL PERHARI

STATUS
EFEKTIF
KETENAG DAERAH VAR (K6)-(K8 x K9) +

HADIR

N
TDK
AAN DAERAH (K7-K8)+(K13)-

1 BL
(K8XK14)

13 14
9
1 2 3 4 5 6 7 8 10 11 12 15
(6/7) (10+11+12) (13/7)
1 dr.Hj.Sri Cahyatiningsih 196810062002122001 IV.b Kepala Puskesmas 69.460.927.2-443.000 150 25 0 30 6.00 40 40 40 120 4.80 325.00
2 Lenia Ratna Susanti 196705131989022006 III.c Ka.Tu 89.256.644.9-443.000 15 25 0 30 1.80 40 40 20 100 4.00 170.00
3 Yanyan Supriatna,AMD,S.IP 196902172007011010 III.a Bendahara JKN 70.629.580.5-443.000 40 25 0 30 2.80 40 40 20 100 4.00 195.00
4 dr.Hj.Sisca Risya Fujiarti 198001012010012008 III.c dr.Fungsional 79.506.558.0-443.000 150 25 1 0 6.00 40 15 20 75 3.00 240.00
5 dr.Khania Puspitasari,MARS 197803012007012008 III.d dr.Fungsional Gigi 66.788.118.9-443.000 150 25 1 0 6.00 40 15 15 70 2.80 235.20
6 Momoh Rohanah, AMK 196407311987032004 III.d Pel.Perawat 78.737.531.0-443.000 40 25 0 0 1.60 40 40 5 85 3.40 150.00
7 Hj.Iis Susilawati, AMK 196712261988032003 III.d Pel.Perawat 25.682.985.4-443.000 40 25 0 0 1.60 40 40 5 85 3.40 150.00
8 Hj.Neneng Kurniasih, Am.Keb 195906191981072001 III.d Bidan Koordinator 87.705.648.1-443.000 40 25 1 0 1.60 40 40 5 85 3.40 144.00
9 Wartinah, AMK 196704211989022001 III.d Pel.Perawat 26.012.366.6-443.000 40 25 0 0 1.60 40 40 5 85 3.40 150.00
10 Hj.Hasanah, S.Kep 196809281995032003 III.d Pel.Perawat 0 60 25 0 0 2.40 40 40 5 85 3.40 170.00
11 Hj.Elis Supyeni, Am.Keb 196712011989032003 III.d Bidan Fungsional 0 40 25 2 0 1.60 40 40 5 85 3.40 138.00
12 Euis Sukmawati, M.Kes 197501301995032001 III.d Sanitarian 0 40 25 2 0 1.60 40 40 5 85 3.40 138.00
13 Tati Sudaryati, AMKG 197206251994022006 III.c Pel.Perawat Gigi 66.803.020.8-443.000 40 25 1 0 1.60 40 40 5 85 3.40 144.00
14 Hj.Lina Zenab,SP 197204161992022001 III.c TPG 0 60 25 0 0 2.40 40 40 5 85 3.40 170.00
15 Mietta Pursitawati,S.Si.Apt III.b Apoteker 25.312.825.0-443.000 50 25 1 0 2.00 40 15 5 60 2.40 129.60
16 Yoseph Ferry, AMK 197803162006041016 III.b Pel.Perawat 24.326.102.1-443.000 40 25 1 0 1.60 40 15 5 60 2.40 120.00
17 Wheni Puspitawati, AMK 198305172005012006 III.b Pel.Perawat 0 40 25 0 0 1.60 40 15 5 60 2.40 125.00
18 Gungun Nurdiansyah,S.Kep 198209272010011018 III.a Pel.Perawat 0 60 25 0 0 2.40 40 15 5 60 2.40 145.00
19 Iis Fatimah,SKM 197904162006042000 II.d Analis / Lab 79.970.844.1-443.000 40 25 2 0 1.60 40 15 5 60 2.40 115.00
20 Hj.Husnul Khotimah,S.ST 197501242007012006 II.d Bidan Fungsional 78.737.497.4-443.000 39.51 25 2 0 1.58 40 35 0 75 3.00 128.35
21 Hj.Rini Lestari, Am.Keb, SE 197509202007012009 II.d Bend.Penerima 89.873.618.6-443.000 39.51 25 1 0 1.58 40 35 10 85 3.40 143.53
22 Ema Asgaritta,S.ST 197710282008012008 II.d Bidan Fungsional 89.873.620.2-443.000 39.51 25 1 0 1.58 40 35 0 75 3.00 133.93
23 Nenden Nuraeni , S.ST 197905142008012024 II.d Bidan Fungsional 89.879.033.2-443.000 39.51 25 5 0 1.58 40 15 0 55 2.20 95.61
24 Ratna Nurhasanah, AMK 198503242011012002 II.c Pel.Perawat 0 39.51 25 1 0 1.58 40 10 5 55 2.20 114.73
25 Yeni Rella 196110232007012001 II.b Pel.Administrasi 25.699.804.8-443.000 15 25 0 0 0.60 40 40 5 85 3.40 125.00
26 Fitri Dwiyani, Am.Keb 198207282014112001 II.a Pel.Perawat 71.701.953.0-443.000 25 25 4 0 1.00 40 10 0 50 2.00 84.00
27 Sipa Nurasvia, AMKG TKK Pel.Perawat Gigi 0 25 25 0 0 1.00 10 15 0 25 1.00 75.00
28 Ricka Rikmasari, AMK TKK Pel.Perawat 0 40 25 0 0 1.60 10 15 0 25 1.00 90.00
29 Dewi Yulianti, AMK TKK Pel.Perawat 0 40 25 0 0 1.60 10 15 5 30 1.20 95.00
30 Nina Widianty TKK Pel.Perawat 71.472.994.4-443.000 25 25 2 0 1.00 10 15 0 25 1.00 69.00
31 Niki Sesbania TKK Pel.Perawat 0 25 25 1 0 1.00 10 15 0 25 1.00 72.00
32 Irma Nurma Diana, AM.Keb PTT Bides Sukakarya 57.951.523.0-443.000 40 25 5 0 1.60 15 25 5 45 1.80 88.00
33 Rina Kurnia Aprianti, Am.Keb PTT Bides Sukagalih 0 40 25 4 0 1.60 15 25 5 45 1.80 92.40
34 Dian Pramesti, Am.Keb PTT Bides Sukajaya 57.951.522.2-443.000 40 25 9 0 1.60 15 25 5 45 1.80 70.40
35 Elis Supriyanti, AMKG TKS Pel.Perawat Gigi 0 25 25 0 0 1.00 5 5 0 10 0.40 60.00
36 M Faisal Ali, S.IP TKS Pel.Administrasi 0 15 25 3 0 0.60 5 5 0 10 0.40 44.00
37 Fatmawati, Am.Keb TKS Bides Mekargalih 0 40 25 0 0 1.60 5 5 5 15 0.60 80.00
38 Hasan Alvian, AMK TKS Pel.Perawat 0 40 25 0 0 1.60 5 5 0 10 0.40 75.00
39 Risna D Yulianti, S.ST TKS Pel.Bidan 36.646.908.8-443.000 40 25 0 0 1.60 5 5 0 10 0.40 75.00
40 H. Subagja Eska Hidayat TKS Operator JKN 35.135.706.6-443.000 15 25 1 0 0.60 5 5 10 20 0.80 57.60
41 Neneng Wulan TKS Pel.Harian Obat 71.473.004.1-443.000 25 25 1 0 1.00 5 5 0 10 0.40 57.60
42 Dadan Nurdiansyah,ST TKS Pel.Administrasi 71.466.360.6-443.000 15 25 0 0 0.60 5 5 0 10 0.40 50.00
43 Tira Febrianti DJ, AMK Magang Pel.Perawat / 0 40 25 0 0 1.60 5 5 0 10 0.40 75.00
44 Moch Rifan Sugandi Magang Pel.Harian Lab 0 25 25 3 0 1.00 5 5 0 10 0.40 52.80
45 Empon Rukmini TKS Cleaning Service 0 15 25 0 0 0.60 5 5 0 10 0.40 50.00
JUMLAH TOTAL 5307.75

Kepala Puskesmas / FKTP Puskesmas Pembangunan

Kecamatan Tarogong Kidul Kabupaten Garut Bendaha
 dr.HJ.SRI CAHYATININGSIH
NIP. 19681006 200212 2 001

98,180,000 58,908,000
Keterangan Pengeluaran
Jumlah Uang sisihan 8,908,000
Honorarium Ka.Puskesmas 1,000,000
Honorarium Bendahara JKN 500,000
Operator JKN 200,000
Verivikator 4 orang 400,000
Jumlah 2,100,000
Saldo 6,808,000

Jumlah sisihan semua 13,755,000

 JASPEL
DITERIMA
JUMLAH
PAJAK PPh
Psl 21 JASPEL TANDA TANGAN
(K11)/TOTAL DITERIMA
POIN X TOTAL
JASPEL

16 17 18 19

3,061,563 153,078 2,908,485 1

1,601,433 80,072 1,521,361 2
1,836,938 91,847 1,745,091 3
2,260,847 113,042 2,147,804 4
2,215,630 110,781 2,104,848 5
1,413,029 70,651 1,342,378 6
1,413,029 70,651 1,342,378 7
1,356,508 67,825 1,288,683 8
1,413,029 70,651 1,342,378 9
1,601,433 80,072 1,521,361 10
1,299,987 64,999 1,234,988 11
1,299,987 64,999 1,234,988 12
1,356,508 67,825 1,288,683 13
1,601,433 80,072 1,521,361 14
1,220,857 61,043 1,159,814 15
1,130,423 56,521 1,073,902 16
1,177,524 58,876 1,118,648 17
1,365,928 68,296 1,297,632 18
 1,083,322 - 1,083,322 19
1,209,074 - 1,209,074 20
1,352,077 - 1,352,077 21
1,261,643 - 1,261,643 22
900,646 - 900,646 23
1,080,775 - 1,080,775 24
1,177,524 - 1,177,524 25
791,296 - 791,296 26
706,515 35,326 671,189 27
847,818 42,391 805,427 28
894,918 44,746 850,173 29
649,993 32,500 617,494 30
678,254 33,913 644,341 31
828,977 41,449 787,528 32
870,426 43,521 826,905 33
663,182 33,159 630,023 34
565,212 28,261 536,951 35
414,489 20,724 393,764 36
753,616 37,681 715,935 37
706,515 35,326 671,189 38
706,515 35,326 671,189 39
542,603 27,130 515,473 40
542,603 27,130 515,473 41
471,010 23,550 447,459 42
706,515 35,326 671,189 43
497,386 24,869 472,517 44
471,010 23,550 447,459 45
50,000,000 2,057,182 47,942,818

Garut, 29 Maret 2015

Bendahara JKN FKTP Puskesmas Pembangunan
YANYAN SUPRIATNA, AMD,S.IP
NIP. 19690217 200701 1 010
 DAFTAR PENERIMAAN
JASA PELAYANAN KAPITASI JAMINAN KESEHATAN NASIONAL (JKN)
UPTD PUSKESMAS PEMBANGUNAN
BULAN JANUARI 2015
TAHUN ANGGARAN 2015
Rp 48,447,000
VARIABEL VARIABEL DAERAH PERHITUNGAN

POINT PER
KEHADIRAN POIN POIN PER ORANG

KEPEGAWAIAN
KETENAGAAN
ORANG JMLH ORG

MASA KERJA
EFEKTIF

JABATAN
No. PETUGAS PUSKESMAS NIP GOL JABATAN NPWP

KINERJA
PERHARI VARIABEL PERHARI

STATUS
TDK HADIR
KETENAG DAERAH VAR (K6)-(K8 x K9) +
AAN DAERAH (K7-K8)+(K13)-

1 BL
(K8XK14)

14
9 13
1 2 3 4 5 6 7 8 10 11 12 15
(6/7) (10+11+12)
(13/7)
1 dr.Hj.Sri Cahyatiningsih 196810062002122001 IV.b Kepala Puskesmas 69.460.927.2-443.000 150 25 0 30 6.00 40 40 40 120 4.80 325.00
2 Lenia Ratna Susanti 196705131989022006 III.c Ka.Tu 15 25 0 30 1.80 40 40 20 100 4.00 170.00
3 Yanyan Supriatna,AMD,S.IP 196902172007011010 III.a Bendahara JKN 70.629.580.5-443.000 40 25 0 30 2.80 40 40 20 100 4.00 195.00
4 dr.Hj.Sisca Risya Fujiarti 198001012010012008 III.c dr.Fungsional 79.506.558.0-443.000 150 25 10 0 6.00 40 15 20 75 3.00 150.00
5 dr.Khania Puspitasari,MARS 197803012007012008 III.d dr.Fungsional Gigi 66.788.118.9-443.000 150 25 10 0 6.00 40 15 15 70 2.80 147.00
6 Momoh Rohanah, AMK 196407311987032004 III.d Pel.Perawat 40 25 1 0 1.60 40 40 5 85 3.40 144.00
7 Hj.Iis Susilawati, AMK 196712261988032003 III.d Pel.Perawat 40 25 0 0 1.60 40 40 5 85 3.40 150.00
8 Hj.Neneng Kurniasih, Am.Keb 195906191981072001 III.d Bidan Koordinator 40 25 0 0 1.60 40 40 5 85 3.40 150.00
9 Wartinah, AMK 196704211989022001 III.d Pel.Perawat 40 25 4 0 1.60 40 40 5 85 3.40 126.00
10 Hj.Hasanah, S.Kep 196809281995032003 III.d Pel.Perawat 60 25 0 0 2.40 40 40 5 85 3.40 170.00
11 Hj.Elis Supyeni, Am.Keb 196712011989032003 III.d Bidan Fungsional 40 25 0 0 1.60 40 40 5 85 3.40 150.00
12 Euis Sukmawati, M.Kes 197501301995032001 III.d Sanitarian 40 25 0 0 1.60 40 40 5 85 3.40 150.00
13 Tati Sudaryati, AMKG 197206251994022006 III.c Pel.Perawat Gigi 66.803.020.8-443.000 40 25 0 0 1.60 40 40 5 85 3.40 150.00
14 Hj.Lina Zenab,SP 197204161992022001 III.c TPG 60 25 0 0 2.40 40 40 5 85 3.40 170.00
15 Mietta Pursitawati,S.Si.Apt III.b Apoteker 50 25 0 0 2.00 40 15 5 60 2.40 135.00
16 Yoseph Ferry, AMK 197803162006041016 III.b Pel.Perawat 40 25 3 0 1.60 40 15 5 60 2.40 110.00
17 Wheni Puspitawati, AMK 198305172005012006 III.b Pel.Perawat 40 25 3 0 1.60 40 15 5 60 2.40 110.00
18 Gungun Nurdiansyah,S.Kep 198209272010011018 III.a Pel.Perawat 60 25 0 0 2.40 40 15 5 60 2.40 145.00
19 Iis Fatimah,SKM 197904162006042000 II.d Analis / Lab 79.970.844.1-443.000 40 25 0 0 1.60 40 15 5 60 2.40 125.00
20 Hj.Husnul Khotimah,S.ST 197501242007012006 II.d Bidan Fungsional 78.737.497.4-443.000 40 25 6 0 1.58 40 35 0 75 3.00 106.03
21 Hj.Rini Lestari, Am.Keb, SE 197509202007012009 II.d Bend.Penerima 40 25 2 0 1.58 40 35 10 85 3.40 137.55
22 Ema Asgaritta,S.ST 197710282008012008 II.d Bidan Fungsional 89.873.620.2-443.000 40 25 0 0 1.58 40 35 0 75 3.00 139.51
23 Nenden Nuraeni , S.ST 197905142008012024 II.d Bidan Fungsional 89.879.033.2-443.000 40 25 0 0 1.58 40 15 0 55 2.20 119.51
24 Ratna Nurhasanah, AMK 198503242011012002 II.c Pel.Perawat 40 25 0 0 1.58 40 10 5 55 2.20 119.51
25 Yeni Rella 196110232007012001 II.b Pel.Administrasi 25.699.804.8-443.000 15 25 0 0 0.60 40 40 5 85 3.40 125.00
26 Fitri Dwiyani, Am.Keb 198207282014112001 II.a Pel.Perawat 71.701.953.0-443.000 25 25 0 0 1.00 40 10 0 50 2.00 100.00
27 Sipa Nurasvia, AMKG TKK Pel.Perawat Gigi 25 25 0 0 1.00 10 15 0 25 1.00 75.00
28 Ricka Rikmasari, AMK TKK Pel.Perawat 40 25 3 0 1.60 10 15 0 25 1.00 79.20
29 Dewi Yulianti, AMK TKK Pel.Perawat 40 25 2 0 1.60 10 15 5 30 1.20 87.40
30 Nina Widianty TKK Pel.Perawat 71.472.994.4-443.000 25 25 0 0 1.00 10 15 0 25 1.00 75.00
31 Niki Sesbania TKK Pel.Perawat 25 25 0 0 1.00 10 15 0 25 1.00 75.00
32 Irma Nurma Diana, AM.Keb PTT Bides Sukakarya 57.951.523.0-443.000 40 25 0 0 1.60 15 25 5 45 1.80 110.00
33 Rina Kurnia Aprianti, Am.Keb PTT Bides Sukagalih 40 25 0 0 1.60 15 25 5 45 1.80 110.00
34 Dian Pramesti, Am.Keb PTT Bides Sukajaya 57.951.522.2-443.000 40 25 0 0 1.60 15 25 5 45 1.80 110.00
35 Elis Supriyanti, AMKG TKS Pel.Perawat Gigi 25 25 0 0 1.00 5 5 0 10 0.40 60.00
36 M Faisal Ali, S.IP TKS Pel.Administrasi 15 25 0 0 0.60 5 5 0 10 0.40 50.00
37 Fatmawati, Am.Keb TKS Bides Mekargalih 40 25 0 0 1.60 5 5 5 15 0.60 80.00
38 Hasan Alvian, AMK TKS Pel.Perawat 40 25 0 0 1.60 5 5 0 10 0.40 75.00
39 Risna D Yulianti, S.ST TKS Pel.Bidan 36.646.908.8-443.000 40 25 0 0 1.60 5 5 0 10 0.40 75.00
40 Asep Rizal Romdhoni,AMK TKS Pel.Perawat 40 25 0 0 1.60 5 5 0 10 0.40 75.00
41 H. Subagja Eska Hidayat TKS Operator JKN 15 25 0 0 0.60 5 5 10 20 0.80 60.00
42 Neneng Wulan TKS Pel.Harian Obat 71.473.004.1-443.000 25 25 0 0 1.00 5 5 0 10 0.40 60.00
43 Dadan Nurdiansyah,ST TKS Pel.Administrasi 71.466.360.6-443.000 15 25 0 0 0.60 5 5 0 10 0.40 50.00
Pel.Perawat /
44 Tira Febrianti DJ, AMK Magang 40 25 0 0 1.60 5 5 0 10 0.40 75.00
Operator JKN
45 Moch Rifan Sugandi Magang Pel.Harian Lab 25 25 0 0 1.00 5 5 0 10 0.40 60.00
46 Empon Rukmini TKS Cleaning Service 15 25 0 0 0.60 5 5 0 10 0.40 50.00

JUMLAH TOTAL 5310.71

Kepala Puskesmas / FKTP Puskesmas Pembangunan
Kecamatan Tarogong Kidul Kabupaten Garut Bend

dr.HJ.SRI CAHYATININGSIH
NIP. 19681006 200212 2 001
 JASPEL
DITERIMA

JUMLAH
PAJAK PPh
Psl 21 JASPEL TANDA TANGAN
(K11)/TOTAL DITERIMA
POIN X TOTAL
JASPEL

16 17 18 19

2,964,817 148,241 2,816,576 1

1,550,827 77,541 1,473,286 2
1,778,890 88,945 1,689,946 3
1,368,377 68,419 1,299,958 4
1,341,010 67,050 1,273,959 5
1,313,642 65,682 1,247,960 6
1,368,377 68,419 1,299,958 7
1,368,377 68,419 1,299,958 8
1,149,437 57,472 1,091,965 9
1,550,827 77,541 1,473,286 10
1,368,377 68,419 1,299,958 11
1,368,377 68,419 1,299,958 12
1,368,377 68,419 1,299,958 13
1,550,827 77,541 1,473,286 14
1,231,539 61,577 1,169,962 15
1,003,477 50,174 953,303 16
 1,003,477 50,174 953,303 17
1,322,765 66,138 1,256,626 18
1,140,314 - 1,140,314 19
967,238 - 967,238 20
1,254,795 - 1,254,795 21
1,272,682 - 1,272,682 22
1,090,232 - 1,090,232 23
1,090,232 - 1,090,232 24
1,140,314 - 1,140,314 25
912,251 - 912,251 26
684,189 34,209 649,979 27
722,503 36,125 686,378 28
797,308 39,865 757,442 29
684,189 34,209 649,979 30
684,189 34,209 649,979 31
1,003,477 50,174 953,303 32
1,003,477 50,174 953,303 33
1,003,477 50,174 953,303 34
547,351 27,368 519,983 35
456,126 22,806 433,319 36
729,801 36,490 693,311 37
684,189 34,209 649,979 38
684,189 34,209 649,979 39
684,189 34,209 649,979 40
547,351 27,368 519,983 41
547,351 27,368 519,983 42
456,126 22,806 433,319 43

684,189 34,209 649,979 44

547,351 27,368 519,983 45

456,126 22,806 433,319 46

48,447,000 1,978,947 46,468,053

 Garut, 29 Maret 2015
Bendahara JKN FKTP Puskesmas Pembangunan

YANYAN SUPRIATNA, AMD,S.IP

NIP. 19690217 200701 1 010