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 JULI 2017

Jmlh hari 25 Total Dana 54998940

BULAN : JULI 2017

VARIABEL Formulasi Perhitungan

Pajak
Persentase Total
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 24 0.96 150 17.00 100.00 10.00 256.32 6,832,882 1,024,932 5,807,949 580,795 5,227,155
1

2 dr.Rismaini 25 1.00 150 14.00 10.00 174.00 4,638,426 231,921 4,406,505 440,650 3,965,854
2

3 Noli Haryono 25 1.00 60 27.00 5.00 5 97.00 2,585,789 129,289 2,456,500 245,650 2,210,850
3

4 Ni nyoman suardi 25 1.00 80 27.00 10.00 117.00 3,118,942 155,947 2,962,995 296,299 2,666,695
4

5 Kurniati 25 1.00 60 26.00 5.00 91.00 2,425,844 121,292 2,304,551 230,455 2,074,096
5

6 Indrawati 25 1.00 80 25.00 10.00 115.00 3,065,627 153,281 2,912,345 291,235 2,621,111
6

7 Siti Rogayah 25 1.00 80 25.00 50.00 5.00 160.00 4,265,220 213,261 4,051,959 405,196 3,646,763
7

8 Arif Irsiyyadi 20 0.80 60 25.00 30.00 15.00 10 112.00 2,985,654 149,283 2,836,371 283,637 2,552,734
8

9 Runi Khaerunisa 24 0.96 80 8.00 5.00 5 94.08 2,507,949 125,397 2,382,552 238,255 2,144,296
9

10 Dewi Komala 25 1.00 80 15.00 5.00 100.00 2,665,762 133,288 2,532,474 253,247 2,279,227
10

11 Lely Mauli 23 0.92 60 12.00 15.00 10 89.24 2,378,926 118,946 2,259,980 225,998 2,033,982
11

12 Kasuhaevi 21 0.84 60 9.00 10.00 66.36 1,769,000 0 1,769,000 176,900 1,592,100

12

13 Ismawati Diah 22 0.88 60 8.00 10.00 5 73.04 1,947,073 0 1,947,073 194,707 1,752,365
13

14 Retno Asri Fitriani 24 0.96 60 2.00 10.00 69.12 1,842,575 0 1,842,575 184,257 1,658,317
14

15 drg taufik 24 0.96 150 3.00 10.00 5 161.28 4,299,341 117,294 4,182,048 418,205 3,763,843
15 2,556,839
16 Rama yanti 25 1.00 60 8.00 10.00 10 88.00 2,345,871 117,294 2,228,577 222,858 2,005,720
16 510,120

17 Yanti Prihatin 24 0.96 60 12.00 10.00 78.72 2,098,488 104,924 1,993,564 199,356 1,794,207
17 3,066,959
18 Ika 25 1.00 60 1.00 5.00 66.00 1,759,403 87,970 1,671,433 167,143 1,504,290
18

19 Leny 25 1.00 25 0.00 0.00 -5 20.00 533,152 26,658 506,495 50,649 455,845
19

20 Deden A Mukti 25 1.00 25 0.00 0.00 -10 15.00 399,864 23,992 375,872 37,587 338,285
20

21 Jaenudin 25 1.00 25 0.00 0.00 -15 10.00 266,576 15,995 250,582 25,058 225,523
21

22 Entong Saputra 25 1.00 25 0.00 0.00 -15 10.00 266,576 15,995 250,582 25,058 225,523
22

- 0 0 0 0

- 0 0

Jumlah 2063.16 54,998,940 3,066,959 51,931,981

54,998,940
Mengetahui/Menyetujui
Kepala UPF Puskesmas Jampang Bendahara JKN UPF 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 JUNI 2017
Jmlh hari 18 Total Dana 523470
BULAN : susulan Juni 2017
Formulasi
VARIABEL
Persentas Perhitungan Pajak
Total
Kehadira e Penamba Point Sebelum PPH 21 TANDA
No NAMA Jenis Rangkap Tanggung Jumlah diterima
n Kehadiran
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 17 1.00 150 17.00 100.00 10.00 278.00 62,485 9,373 53,112
1

2 dr.Rismaini 13 0.83 150 14.00 10.00 174.83 39,297 1,965 37,332

2

3 Noli Haryono 18 1.00 60 27.00 15.00 5.00 108.00 24,275 1,214 23,061
3

4 Ni nyoman suardi 18 1.00 80 27.00 5.00 113.00 25,399 1,270 24,129

4

5 Kurniati 18 1.00 60 27.00 10.00 98.00 22,027 1,101 20,926

5

6 Indrawati 17 1.00 80 26.00 5.00 112.00 25,174 3,776 21,398

6

7 Siti Rogayah 18 1.00 80 25.00 10.00 116.00 26,073 1,304 24,769

7

8 Arif Irsiyyadi 18 1.00 60 25.00 50.00 5.00 141.00 31,692 1,585 30,107
8

9 Runi Khaerunisa 18 1.00 80 25.00 15.00 20.00 141.00 31,692 1,585 30,107
9

10 Dewi Komala 18 1.00 80 8.00 5.00 94.00 21,128 1,056 20,072

10

11 Lely Mauli 18 0.29 60 15.00 10.00 85.29 19,171 959 18,212

11

12 Kasuhaevi 16 1.00 60 12.00 15.00 88.00 19,779 0 19,779

12

13 Ismawati Diah 15 0.83 60 9.00 5.00 74.83 16,820 0 16,820

13

14 Retno Asri Fitriani 18 1.00 60 8.00 10.00 79.00 17,756 0 17,756

14

15 drg taufik 18 1.00 150 5.00 5.00 161.00 36,187 1,809 34,378
15
16 Rama yanti 18 1.00 150 3.00 10.00 164.00 36,862 1,843 35,018 16

17 Yanti Prihatin 18 1.00 60 8.00 10.00 79.00 17,756 888 16,869

17
18 Ika 18 1.00 60 12.00 10.00 83.00 18,656 933 17,723
18

19 Leny 18 1.00 60 0.00 0.00 61.00 13,711 686 13,025

19

20 Deden A Mukti 18 1.00 25 0.00 0.00 26.00 5,844 351 5,493

20

21 Jaenudin 18 1.00 25 0.00 0.00 26.00 5,844 351 5,493

21

22 Entong Saputra 18 1.00 25 0.00 0.00 26.00 5,844 351 5,493

22

23 - 25 10.00 0.00 0
23

2328.96 523,470 32,397 491,073

Jumlah
523,470
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 : 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 6,832,882 1,024,932 5,807,949

19661118.200208.2.003 IV A 24.850.609.9-403.000 1

2 dr.Rismaini 4,638,426 231,921 4,406,505

19760111.200701.2.006 III D 36.299.269.5-403.000 2

3 Noli Haryono 2,585,789 129,289 2,456,500

19640327.199012.2.001 III D 69.732.771.0.403.000 3

4 Ni nyoman suardi 3,118,942 155,947 2,962,995

19701209.199002.2.001 III D 69.732.769.0-403.000 4

5 Kurniati 2,425,844 121,292 2,304,551

19680708.199103.2.006 III C 69.732.777.4-403.000 5

6 Indrawati 3,065,627 153,281 2,912,345

19720813.199203.2.003 III D 35.314.553.5-434.000 6

7 Siti Rogayah 4,265,220 213,261 4,051,959

19711215.199203.2.003 III C 73.554.417.3-403.000 7

8 Arif Irsiyyadi 2,985,654 149,283 2,836,371

19730411.199203.1.001 III C 73.544.521.5-412.000 8 2,556,839
9 Runi Khaerunisa 2,507,949 125,397 2,382,552
19790603.201001.2.006 III A 58.214.772.4-411.000 9 510,120
10 Dewi Komala 2,665,762 133,288 2,532,474
198101172008012002 III A 34.850.441.6-403.000 10 3,066,959
11 Lely Mauli 2,378,926 118,946 2,259,980
19750404.200501.2.011 III A 09.208.547.1-403.001 11

12 Kasuhaevi 1,769,000 2,556,839 1,769,000

198306012011012001 II D 34.850.441.6-403.000 12

13 Ismawati Diah 1,947,073 0 1,947,073

198310012012112001 II D 73.072.571.0-403.000 13

14 Retno Asri Fitriani 1,842,575 0 1,842,575

199203292015012000 II C 54.054.225.5-403.000 14

15 drg taufik 4,299,341 117,294 4,182,048

1000673 PTT 72.128.677.1-016.000 15

16 Rama yanti 2,345,871 117,294 2,228,577

5000518 PTT 73.554.417.3-403.000 16

17 Yanti Prihatin 2,098,488 104,924 1,993,564

6 PTT 71.636.989.7-404.000 17

18 Ika 1,759,403 87,970 1,671,433

4000837 PTT 70.391.400.2-434.000 18
19 Lenny 533,152 26,658 506,495
Honor 19

20 Deden A Mukti 399,864 23,992 375,872

Honor 20

21 Jaenudin 266,576 15,995 250,582

Honor 21

22 Entong Saputra 266,576 15,995 250,582

Honor 22

- 510,120 0

54,998,940 3,066,959 51,931,981

Jumlah Jumlah

Terbilang : /// Lima Puluh Empat Juta Sembilan Ratus Sembilan Puluh Delapan Ribu Sembilan Ratus Empat Puluh Ribu 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 : JUNI 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 62,485 9,373 53,112 1
2 dr.Rismaini 19760111.200701.2.006 III D 36.299.269.5-403.000 39,297 1,965 37,332 2
3 Noli Haryono 19640327.199012.2.001 III D 69.732.771.0.403.000 24,275 1,214 23,061 3
4 Ni nyoman suardi 19701209.199002.2.001 III D 69.732.769.0-403.000 25,399 1,270 24,129 4
5 Kurniati 19680708.199103.2.006 III C 69.732.777.4-403.000 22,027 1,101 20,926 5
6 Indrawati 19720813.199203.2.003 III D 35.314.553.5-434.000 25,174 3,776 21,398 6
7 Siti Rogayah 19711215.199203.2.003 III C 73.554.417.3-403.000 26,073 1,304 24,769 7
8 Arif Irsiyyadi 19730411.199203.1.001 III C 73.544.521.5-412.000 31,692 1,585 30,107 8
9 Runi Khaerunisa 19790603.201001.2.006 III A 58.214.772.4-411.000 31,692 1,585 30,107 9

10 Dewi Komala
198101172008012002 III A 34.850.441.6-403.000 21,128 1,056 20,072 10
11 Lely Mauli 19750404.200501.2.011 III A 09.208.547.1-403.001 19,171 959 18,212 11
12 Kasuhaevi 198306012011012001 II D 34.850.441.6-403.000 19,779 19,779 12
13 Ismawati Diah 198310012012112001 II D 73.072.571.0-403.000 16,820 0 16,820 13

15 Retno Asri Fitriani 199203292015012000 II C 54.054.225.5-403.000 17,756 0 17,756 14

16 drg taufik 1000673 PTT 72.128.677.1-016.000 36,187 1,809 34,378 15

17 Rama yanti
5000518 PTT 73.554.417.3-403.000 36,862 1,843 35,018 16

18 Yanti Prihatin 17,756

6 PTT 71.636.989.7-404.000 888 16,869 17
19 Ika 18,656
4000837 PTT 70.391.400.2-434.000 933 17,723 18

20 Lenny 13,711
Honor 686 13,025 19

21 Deden A Mukti
Honor 5,844 351 5,493 20

22 Jaenudin
Honor 5,844 351 5,493 21

23 Entong Saputra
Honor 5,844 351 5,493 22

7,210

Jumlah Jumlah 523,470 32,397 491,073

Terbilang : /// Lima Ratus Dua Puluh Tiga Ribu Empat Ratus Tujuh 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!
 6,832,882 1,024,932 5,807,949 62,485 9,373 53,112 6,895,367
4,638,426 231,921 4,406,505 39,297 1,965 37,332 4,677,723
2,585,789 129,289 2,456,500 24,275 1,214 23,061 2,610,064
3,118,942 155,947 2,962,995 25,399 1,270 24,129 3,144,340
2,425,844 121,292 2,304,551 22,027 1,101 20,926 2,447,871
3,065,627 153,281 2,912,345 25,174 3,776 21,398 3,090,800
4,265,220 213,261 4,051,959 26,073 1,304 24,769 4,291,292
2,985,654 149,283 2,836,371 31,692 1,585 30,107 3,017,346
2,507,949 125,397 2,382,552 31,692 1,585 30,107 2,539,641
2,665,762 133,288 2,532,474 21,128 1,056 20,072 2,686,890
2,378,926 118,946 2,259,980 19,171 959 18,212 2,398,097
1,769,000 0 1,769,000 19,779 0 19,779 1,788,779
1,947,073 0 1,947,073 16,820 0 16,820 1,963,893
1,842,575 0 1,842,575 17,756 0 17,756 1,860,331
4,299,341 117,294 4,182,048 36,187 1,809 34,378 4,335,529
2,345,871 117,294 2,228,577 36,862 1,843 35,018 2,382,732
2,098,488 104,924 1,993,564 17,756 888 16,869 2,116,245
1,759,403 87,970 1,671,433 18,656 933 17,723 1,778,059
533,152 26,658 506,495 13,711 686 13,025 546,863
399,864 23,992 375,872 5,844 351 5,493 405,708
266,576 15,995 250,582 5,844 351 5,493 272,420
266,576 15,995 250,582 5,844 351 5,493 272,420
- 0 0 0 -
- 523,470 32,397 491,073
54,998,940 3,066,959 51,931,981
1,034,305 5,861,062
233,886 4,443,837
130,503 2,479,561
157,217 2,987,123
122,394 2,325,477
157,057 2,933,743
214,565 4,076,728
150,867 2,866,478
126,982 2,412,659
134,345 2,552,546
119,905 2,278,192
0 1,788,779
0 1,963,893
0 1,860,331
119,103 4,216,426
119,137 2,263,596
105,812 2,010,432
88,903 1,689,156
27,343 519,520
24,342 381,366
16,345 256,075
16,345 256,075
0
Kode Program : 16. Kode Kegiatan : 0318 Kode Rek : 5.2.2.03.12
Kwitansi
Nomor : 054 /spj /VIII /2017
Telah terima dari : Dana Kapitasi JKN FKTP Puskesmas Jampang
Lima Puluh Empat Juta Sembilan Ratus Sembilan Puluh Delapan Ribu Sembilan Ratus Empat Puluh Rupiah
Uang sejumlah :

Untuk pembayaran : Pembayaran Jaspel JKN Bulan Juli 2017

Rp. 54,998,940 LUNAS DIBAYAR

Pot. Pajak = TGL BKU15 Agustus2017 Cibinong , 15 Agustus 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 : 055 /spj /VIII /2017
Telah terima dari : Dana Kapitasi JKN FKTP Puskesmas Jampang

Uang sejumlah : Lima Ratus Dua Puluh Tiga Ribu Empat Ratus Tujuh Puluh Rupiah

Untuk pembayaran : Pembayaran Jaspel Susulan Bulan Juni 2017

Rp. 523,470 LUNAS DIBAYAR

Pot. Pajak = TGL BKU15 Agustus2017 Cibinong , 15 Agustus 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
 6,678,800 1,001,820 5,676,980 109,512 16,427 93,085 6,788,311 1,018,247 5,770,065
4,477,547 223,877 4,253,670 70,841 3,542 67,299 4,548,389 227,419 4,320,969
2,301,309 115,065 2,186,244 42,544 2,127 40,417 2,343,853 117,193 2,226,661
2,926,665 146,333 2,780,332 44,514 2,226 42,288 2,971,179 148,559 2,822,620
2,276,295 113,815 2,162,480 38,605 1,930 36,675 2,314,900 115,745 2,199,155
2,636,917 131,846 2,505,071 44,120 6,618 37,502 2,681,037 138,464 2,542,573
4,127,348 206,367 3,920,981 45,696 2,285 43,411 4,173,044 208,652 3,964,391
3,627,063 181,353 3,445,710 55,544 2,777 52,767 3,682,607 184,130 3,498,477
2,451,395 122,570 2,328,825 55,544 2,777 52,767 2,506,938 125,347 2,381,591
2,501,423 125,071 2,376,352 37,029 1,851 35,178 2,538,452 126,923 2,411,530
2,301,309 115,065 2,186,244 33,599 1,680 31,919 2,334,908 116,745 2,218,163
4,202,391 210,120 3,992,271 63,422 3,171 60,251 4,265,813 213,291 4,052,522
2,201,252 110,063 2,091,190 64,604 3,230 61,374 2,265,856 113,293 2,152,564
2,176,238 108,812 2,067,426 31,120 1,556 29,564 2,207,358 110,368 2,096,990
1,625,925 81,296 1,544,629 32,696 1,635 31,061 1,658,621 82,931 1,575,690
500,285 30,017 470,268 24,030 1,201 22,828 524,314 31,219 493,096
375,213 22,513 352,701 10,242 615 9,628 385,456 23,127 362,328
250,142 15,009 235,134 10,242 615 9,628 260,384 15,623 244,761
250,142 15,009 235,134 10,242 615 9,628 260,384 15,623 244,761
47,887,661 3,076,021 44,811,640 824,145 56,878 767,268 48,711,806 3,132,899 45,578,907

48,711,806
48,711,806
3,132,899
45,578,907