ESTIMASI PENDAPATAN DAN BELANJA BLUD 2019 ESTIMASI ANGGARAN PERUBAHAN PENDAPATAN DAN BELANJA BLUD 2019
PAGU DPA SILPA 2018
NO NAMA PUSKESMAS Pembulatan
RETRIBUSI KAPITASI NON KAPITASI MURNI 2019 KAPITASI
KAPITASI NON KAPITASI RETRIBUSI TOTAL SILPA
1 ANJATAN 31,635,000 1,469,907,000 73,920,000 1,575,462,000 0 1,575,462,000 13,881,450 8,252,750 19,096,000 41,230,200 1,469,907,000
2 BABADAN 12,918,000 591,192,000 767,344 604,877,344 44 604,877,300 71,199,995 - 7,963,900 79,163,895 591,192,000
3 BALONGAN 41,119,500 1,791,102,000 44,550,000 1,876,771,500 0 1,876,771,500 179,713,911 12,200,000 42,233,500 234,147,411 1,791,102,000
4 BANGODUA 38,445,000 1,266,564,000 53,714,083 1,358,723,083 83 1,358,723,000 46,047,841 3,255,000 9,999,000 59,301,841 1,266,564,000
5 BONGAS 42,994,500 1,156,509,000 233,574,000 1,433,077,500 0 1,433,077,500 1,317,144 26,432,498 4,994,550 32,744,192 1,156,509,000
6 BUGIS 16,905,000 1,574,421,300 102,600,294 1,693,926,594 94 1,693,926,500 1,769,933 9,280,687 1,990,100 13,040,720 1,574,421,300
7 CANTIGI 32,304,000 1,260,195,300 59,400,000 1,351,899,300 0 1,351,899,300 54,791,107 3,885,000 11,755,594 70,431,701 1,260,195,300
8 CEMARA 28,956,000 779,851,800 40,496,582 849,304,382 82 849,304,300 23,014,670 5,996,500 12,007,000 41,018,170 779,851,800
9 CIDEMPET 42,079,500 1,180,831,500 100,122,000 1,323,033,000 0 1,323,033,000 24,588,195 5,305,500 13,794,150 43,687,845 1,180,831,500
10 CIKEDUNG 47,508,000 2,030,173,200 60,428,344 2,138,109,544 44 2,138,109,500 28,460,006 1,896,000 21,443,000 51,799,006 2,030,173,200
11 CIPANCUH 23,796,000 1,192,768,500 56,265,000 1,272,829,500 0 1,272,829,500 21,490,697 5,497,500 31,361,000 58,349,197 1,192,768,500
12 DRUNTEN WETAN 30,798,000 827,544,600 93,786,000 952,128,600 0 952,128,600 20,927,852 4,898,250 10,100,300 35,926,402 827,544,600
13 GABUSWETAN 57,855,000 1,720,045,800 140,316,000 1,918,216,800 0 1,918,216,800 404,058,255 39,535,500 31,283,000 474,876,755 1,720,045,800
14 GANTAR 80,133,000 2,314,839,600 107,910,000 2,502,882,600 0 2,502,882,600 353,748,296 13,562,500 26,113,500 393,424,296 2,314,839,600
15 HAURGEULIS 36,501,000 2,141,042,400 173,464,516 2,351,007,916 16 2,351,007,900 87,773,398 1,400,000 24,056,400 113,229,798 2,141,042,400
16 JATIBARANG 97,671,000 2,979,806,400 83,490,000 3,160,967,400 0 3,160,967,400 - 20,520,000 40,329,666 60,849,666 2,979,806,400
17 JATISAWIT 35,664,000 981,366,300 63,000,000 1,080,030,300 0 1,080,030,300 63,981,328 3,250,499 11,240,500 78,472,327 981,366,300
18 JUNTINYUAT 38,697,000 2,000,241,000 15,001,576 2,053,939,576 76 2,053,939,500 285,922,942 2,081,049 14,169,396 302,173,387 2,000,241,000
19 KANDANGHAUR 19,862,291 1,892,118,000 225,225,000 2,137,205,291 91 2,137,205,200 - 7,277,000 25,631,216 32,908,216 1,892,118,000
20 KAPLONGAN 17,638,000 574,983,900 168,360,000 760,981,900 0 760,981,900 1,869,388 10,473,750 6,636,200 18,979,338 574,983,900
21 KARANGAMPEL 26,283,000 2,005,429,800 79,332,000 2,111,044,800 0 2,111,044,800 15,377,245 7,297,500 11,183,000 33,857,745 2,005,429,800
22 KEDOKAN BUNDER 47,678,000 2,276,275,500 77,940,000 2,401,893,500 0 2,401,893,500 36,313,176 2,036,750 19,494,000 57,843,926 2,276,275,500
23 KEDUNGWUNGU 27,406,500 1,565,789,400 4,028,556 1,597,224,456 56 1,597,224,400 316,803,540 - 6,427,650 323,231,190 1,565,789,400
24 KERTASEMAYA 123,897,000 3,576,463,200 146,157,000 3,846,517,200 0 3,846,517,200 339,086,514 37,392,000 76,891,250 453,369,764 3,576,463,200
25 KERTAWINANGUN 70,548,000 1,494,560,700 80,640,000 1,645,748,700 0 1,645,748,700 64,681,726 8,645,000 31,295,700 104,622,426 1,494,560,700
26 KERTICALA 42,612,000 910,882,800 171,854,000 1,125,348,800 0 1,125,348,800 15,979,834 5,747,500 1,271,999 22,999,333 910,882,800
27 KIAJARAN WETAN 18,783,000 756,564,300 42,100,000 817,447,300 0 817,447,300 73,006,716 1,679,000 7,582,500 82,268,216 756,564,300
28 KRANGKENG 32,740,800 1,589,697,900 73,920,000 1,696,358,700 0 1,696,358,700 874,290 4,541,250 33,531,500 38,947,040 1,589,697,900
29 KROYA 11,034,000 1,239,826,500 106,260,000 1,357,120,500 0 1,357,120,500 11,376,609 4,200,000 18,841,000 34,417,609 1,239,826,500
30 LELEA 45,511,500 1,075,758,300 3,325,158 1,124,594,958 58 1,124,594,900 114,808,990 420,000 31,112,000 146,340,990 1,075,758,300
31 LOHBENER 28,980,090 1,255,179,000 134,805,000 1,418,964,090 90 1,418,964,000 6,672,910 4,200,000 20,007,000 30,879,910 1,255,179,000
32 LOSARANG 56,775,000 1,170,378,000 6,944,464 1,234,097,464 64 1,234,097,400 8,026,127 6,302,700 20,191,700 34,520,527 1,170,378,000
33 MARGADADI 87,684,000 2,438,322,000 92,400,000 2,618,406,000 0 2,618,406,000 303,790,919 10,202,000 14,009,000 328,001,919 2,438,322,000
34 PASEKAN 12,534,000 1,353,849,000 105,039,000 1,471,422,000 0 1,471,422,000 28,878,337 24,555,000 15,273,000 68,706,337 1,353,849,000
35 PATROL 49,710,000 2,208,834,900 212,124,000 2,470,668,900 0 2,470,668,900 27,453,240 - 3,346,750 30,799,990 2,208,834,900
36 PLUMBON 67,695,000 1,933,242,000 23,100,000 2,024,037,000 0 2,024,037,000 333,816,634 10,000 33,201,900 367,028,534 1,933,242,000
37 PONDOH 28,689,000 1,249,576,200 72,930,000 1,351,195,200 0 1,351,195,200 44,606,465 25,019,000 22,233,000 91,858,465 1,249,576,200
38 SIDAMULYA 8,733,000 991,861,200 21,000,000 1,021,594,200 0 1,021,594,200 105,748,974 8,400,000 6,196,000 120,344,974 991,861,200
39 SINDANG 32,736,000 1,103,020,200 52,590,000 1,188,346,200 0 1,188,346,200 39,926,648 14,200,000 23,385,000 77,511,648 1,103,020,200
40 SLIYEG 27,948,000 1,247,092,200 147,840,000 1,422,880,200 0 1,422,880,200 56,750,042 32,790,000 26,218,000 115,758,042 1,247,092,200
41 SUKAGUMIWANG 28,764,000 1,207,658,700 110,088,000 1,346,510,700 0 1,346,510,700 356,852 9,225,000 12,065,500 21,647,352 1,207,658,700
42 SUKRA 101,823,000 2,182,732,200 79,931,672 2,364,486,872 571 2,364,486,301 644,597,555 20,255,000 39,916,850 704,769,405 2,182,732,200
43 TAMBI 20,056,500 845,553,600 33,363,000 898,973,100 0 898,973,100 11,318,399 7,974,000 19,590,500 38,882,899 845,553,600
44 TEMIYANG 44,340,000 1,631,056,500 116,000,000 1,791,396,500 0 1,791,396,500 116,314,262 4,333,000 11,878,500 132,525,762 1,631,056,500
45 TERISI 57,639,000 2,812,136,400 116,820,000 2,986,595,400 0 2,986,595,400 473,299,576 46,905,000 24,950,000 545,154,576 2,812,136,400
46 TUGU 37,113,000 849,093,300 30,198,185 916,404,485 85 916,404,400 1,465,898 - 16,656,700 18,122,598 849,093,300
47 TUKDANA 30,164,000 1,155,929,400 78,890,000 1,264,983,400 0 1,264,983,400 155,919,101 4,962,750 40,340,500 201,222,351 1,155,929,400
48 WANAKAYA 23,178,000 1,254,606,300 95,865,000 1,373,649,300 0 1,373,649,300 50,880,189 17,295,000 13,473,000 81,648,189 1,254,606,300
49 WIDASARI 50,157,000 1,851,656,400 344,775,000 2,246,588,400 0 2,246,588,400 12,985,543 12,606,750 23,961,249 49,553,542 1,851,656,400
JUMLAH 2,014,692,181 74,958,529,500 4,556,650,773 81,529,872,454 81,529,871,000 5,095,672,719 506,194,183 990,722,720 6,592,589,622 74,958,529,500
5,095,672,719 506,194,183 990,722,720 6,592,589,622 74,958,529,500
DAPATAN DAN BELANJA BLUD 2019
1,511,137,200
670,355,895
2,025,249,411
1,325,865,841
1,189,253,192
1,587,462,020
1,330,627,001
820,869,970
1,224,519,345
2,081,972,206
1,251,117,697
863,471,002
2,194,922,555
2,708,263,896
2,254,272,198
3,040,656,066
1,059,838,627
2,302,414,387
1,925,026,216
593,963,238
2,039,287,545
2,334,119,426
1,889,020,590
4,029,832,964
1,599,183,126
933,882,133
838,832,516
1,628,644,940
1,274,244,109
1,222,099,290
1,286,058,910
1,204,898,527
2,766,323,919
1,422,555,337
2,239,634,890
2,300,270,534
1,341,434,665
1,112,206,174
1,180,531,848
1,362,850,242
1,229,306,052
2,887,501,605
884,436,499
1,763,582,262
3,357,290,976
867,215,898
1,357,151,751
1,336,254,489
1,901,209,942
0 0 81,551,119,122
81,551,119,122
RENCANA KERJA DAN ANGGARAN
SATUAN KERJA PERANGKAT DAERAH
KABUPATEN INDRAMAYU
TAHUN ANGGARAN 2019
Urusan Pemerintahan : 1 02 Urusan Wajib Pelayanan Kesehatan Dasar
Organisasi : 1 02 01 DINAS KESEHATAN
Sub Unit Organisasi : 1 02 01 ....... PUSKESMAS ..................................
RINCIAN PERUBAHAN ANGGARAN PENDAPATAN SATUAN KERJA PERANGKAT DAERAH
Sebelum Perubahan Setelah Perubahan
Rincian Perhitungan Rincian Perhitungan
Kode Rekening URAIAN
Volu Harga Jumlah Harga
Satuan Volume Satuan
me Satuan Satuan
1 2 3 4 5 6=3 x 5 7 8 9
4 PENDAPATAN
4 1 PENDAPATAN ASLI DAERAH
4 1 4 LAIN-LAIN PENDAPATAN ASLI DAERAH YANG SAH
4 1 4 16 Pendapatan BLUD
4 1 4 16 01 Pendapatan Jasa Layanan Umum BLUD
- Pendapatan Jasa Layanan Umum BLUD ( Retribusi )
......................................................
NIP. .............................................
Jumlah Jumlah %
10=7 x 9 11 = (10-6) 12
..............................
.............................
TANDA TANGAN
......................................................
NIP. .............................................
Jumlah Jumlah %
10=7 x 9 11 = (10-6) 12
..............................
.............................
TANDA TANGAN
Terlaksananya pelayanan kesehatan bagi peserta Program JKN yang Terlaksananya pelayanan kesehatan bagi peserta Program JKN yang membutuhkan
membutuhkan pelayanan kesehatan di Fasilitas Kesehatan Tingkat pelayanan kesehatan di Fasilitas Kesehatan Tingkat Pertama
KELUARAN
Pertama
HASIL Terlayaninya peserta Program Jaminan Kesehatan Nasional (JKN) Terlayaninya peserta Program Jaminan Kesehatan Nasional (JKN)
5 2 3 BELANJA MODAL
5 2 3 16 Belanja Modal Peralatan dan Mesin - Pengadaan Alat -alat bantu
5 2 3 16 04 Belanja Modal Peralatan dan Mesin - Pengadaan Electric Generating Set
5 2 3 26 Belanja Modal Peralatan dan Mesin - Pengadaan Alat Pemeliharaan Tanaman/Alat Penyimpan
5 2 3 26 01 Belanja Modal Peralatan dan Mesin - Pengadaan Alat Pemeliharaan Tanaman
5 2 3 48 Belanja Modal Peralatan dan Mesin - Pengadaan Alat Keamanan dan Perlindungan
5 2 3 48 01 Belanja Modal Peralatan dan Mesin - Pengadaan Alat Bantu Keamanan
5 2 3 49 Belanja Modal Peralatan dan Mesin - Pengadaan Bangunan Gedung Tempat Kerja
5 2 3 49 27 Belanja Modal Peralatan dan Mesin - Pengadaan pelengkap Bangunan Gedung Tempat Kerja
JUMLAH BELANJA 0
Indramayu, …………………………………..
......................................................
NIP. .............................................
Keterangan :
Tanggal Pembahasan :
Catatan Hasil Pembahasan :
1.
2.
Dst
Tim Anggaran Pemerintah Daerah
No Nama NIP JABATAN
1
2
3
nal (JKN)
GKAT DAERAH
Perubahan Bertambah/ (Berkurang)
Jumlah Jumlah %
10=7 x 9 11 = (10-6) 12
…………………………..
..............................
.............................
JABATAN
1 JAN RIIL
2 FEB RIIL
3 MARET RIIL
4 APRIL KLAIM
5 MEI KLAIM
6 JUNI KLAIM
7 JULI ESTIMASI
8 AGST ESTIMASI
9 SEPT ESTIMASI
10 OKT ESTIMASI
11 NOV ESTIMASI
12 DES ESTIMASI
TOTAL
PEMERINTAH KABUPATEN INDRAMAYU
UPTD PUSKESMAS………………………………….
RENCANA BISNIS DAN ANGGARAN BELANJA PERUBAHAN TAHUN ANGGARAN 2019
SEBELUM PERUBAHAN
Sumber Dana
Pendapatan Layanan Umum Daerah ( Rp. ) Pendapatan Lay
NO URAIAN Kerjasama ( Kapitasi dan Non JUMLAH
Jasa Layanan APBD Jasa Layanan
Hibah Kapitasi ) Lain-lain
( Retribusi ) Kapitasi Non Kapitasi ( Retribusi )
BELANJA
1 BELANJA OPERASI Rp - Rp - Rp - Rp - Rp - Rp - Rp - Rp -
1.1. Biaya Pegawai Rp - Rp - Rp - Rp - Rp - Rp - Rp - Rp -
1.1. 1 Honorarium Pegawai BLUD : Rp -
- Perawat Rp -
- Bidan Rp -
- apoteker Rp -
- asisten apoteker Rp -
- Sanitarian Rp -
1.1. 2 Honorarium Piket PNS Rp -
1.1. 3 Honorarium Piket Non PNS Rp -
1.1. 4 Uang Saku PNS Rp -
1.1. 5 Uang Saku Non PNS Rp -
1.1. 6 Uang Lembur PNS Rp -
1.1. 7 Uang Lembur Non PNS Rp -
1.1. 8 THR Rp -
1.1. 9 ................................ Rp -
1.1. 10 ................................ Rp -
1.1. 11 ................................ Rp -
1.1. 12 ................................ Rp -
1.1. dst Rp -
Rp -
1.2 BIAYA BARANG DAN JASA Rp - Rp - Rp - Rp - Rp - Rp - Rp - Rp -
1.2. 1 Belanja Listrik Rp -
1.2. 2 Belanja air Rp -
1.2. 3 Belanja internet Rp -
SEBELUM PERUBAHAN
Sumber Dana
Pendapatan Layanan Umum Daerah ( Rp. ) Pendapatan Lay
NO URAIAN Kerjasama ( Kapitasi dan Non JUMLAH
Jasa Layanan APBD Jasa Layanan
Hibah Kapitasi ) Lain-lain
( Retribusi ) Kapitasi Non Kapitasi ( Retribusi )
KPA
PUSKESMAS ............................... PPTK BLUD
......................................... .........................................
NIP. ............................... NIP. ...............................
SETELAH PERUBAHAN
Sumber Dana
Pendapatan Layanan Umum Daerah ( Rp. )
BERTAMBAH /
Kerjasama ( Kapitasi dan JUMLAH BERKURANG
Non Kapitasi ) APBD
Hibah Lain-lain
Kapitasi Non Kapitasi
Rp - Rp - Rp - Rp - Rp - Rp - Rp -
Rp - Rp - Rp - Rp - Rp - Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp - Rp - Rp - Rp - Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
SETELAH PERUBAHAN
Sumber Dana
Pendapatan Layanan Umum Daerah ( Rp. )
BERTAMBAH /
Kerjasama ( Kapitasi dan JUMLAH BERKURANG
Non Kapitasi ) APBD
Hibah Lain-lain
Kapitasi Non Kapitasi
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
SETELAH PERUBAHAN
Sumber Dana
Pendapatan Layanan Umum Daerah ( Rp. )
BERTAMBAH /
Kerjasama ( Kapitasi dan JUMLAH BERKURANG
Non Kapitasi ) APBD
Hibah Lain-lain
Kapitasi Non Kapitasi
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp - Rp - Rp - Rp - Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp -
Rp - Rp - Rp - Rp - Rp - Rp - Rp -