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Lima Puluh Delapan Juta Tiga Ratus

58,346,737 Empat Puluh Enam Ribu Tujuh Ratus


Tiga Puluh Tujuh
Lima Puluh Lima Ribu
55,000

Delapan Puluh Sembilan Juta Lima


89,549,915 Ratus Empat Puluh Sembilan Ribu
Sembilan Ratus Lima Belas
Delapan Puluh Delapan Juta Tiga
88,361,719 Ratus Enam Puluh Satu Ribu Tujuh
Ratus Sembilan Belas
Sepuluh Ribu
10,000

Seratus
100

Seratus
100

Seratus
100

Seratus
100

Seratus
100

Seratus
100

Seratus
100

Seratus
100

Seratus
100

Seratus
100
PEMERINTAH KABUPATEN JOMBANG
BUKU KAS UMUM
BLUD PUSKESMAS JATIWATES
periode : 01 Mei 2020 s/d 31 Mei 2020

NO. KODE
NO. TGL BUKTI
URAIAN REKENING
REF PENERIMAAN PENGELUARAN SALDO
1 Saldo Bulan Lalu - 119,619,897.00
2 01-05-2020 Bunga Bank 4.1.4.20 229,537.92 119,849,434.92
3 02-05-2020 Tindakan / Operasi 4.1.2.01.12 10,000.00 119,859,434.92
4 02-05-2020 Administrasi Karcis 4.1.2.01.11 95,000.00 119,954,434.92
5 02-05-2020 Laboratorium 4.1.2.01.17 110,000.00 120,064,434.92
6 04-05-2020 Laboratorium 4.1.2.01.17 50,000.00 120,114,434.92
7 04-05-2020 Administrasi Karcis 4.1.2.01.11 60,000.00 120,174,434.92
8 04-05-2020 Honor sukwan bln April a.n Dedik 5.2.1.07.01 200,000.00 119,974,434.92
Catur
9 04-05-2020 Honor sukwan bln April a.n Lina 5.2.1.07.01 200,000.00 119,774,434.92
Wati
10 04-05-2020 Honor Sukawan ln April a.n Delinda 5.2.1.07.01 200,000.00 119,574,434.92
Poppy
11 04-05-2020 Belanja BBM Pusling bln April 5.2.2.26.01 200,000.00 119,374,434.92
12 04-05-2020 Belanja servis komputer bln Januari 5.2.2.26.01 1,200,000.00 118,174,434.92
13 04-05-2020 Belanja suku cadang computer 5.2.2.26.01 1,500,000.00 116,674,434.92
bulan januari
14 04-05-2020 Belanja cetak bln Feb, Maret 5.2.3.27.04 13,060,000.00 103,614,434.92
15 05-05-2020 Administrasi Karcis 4.1.2.01.11 60,000.00 103,674,434.92
16 05-05-2020 Laboratorium 4.1.2.01.17 122,000.00 103,796,434.92
17 05-05-2020 Pajak belanja CCTV bln April 731,817.00 103,064,617.92
18 05-05-2020 Belanja CCTV bln April 6,268,183.00 96,796,434.92
19 06-05-2020 Laboratorium 4.1.2.01.17 47,000.00 96,843,434.92
20 06-05-2020 Administrasi Karcis 4.1.2.01.11 80,000.00 96,923,434.92
21 08-05-2020 Administrasi Karcis 4.1.2.01.11 100,000.00 97,023,434.92
22 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 350,000.00 96,673,434.92
Asna Rofiko
23 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 525,000.00 96,148,434.92
Sulastri
24 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 541,737.00 95,606,697.92
Delinda P
25 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 541,737.00 95,064,960.92
Dedik Catur
26 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 553,096.00 94,511,864.92
Eka retno
27 08-05-2020 Remunerai insentif pegawai a/n 5.2.2.26.01 570,135.00 93,941,729.92
Nur kasan
28 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 646,541.00 93,295,188.92
Lina wati
29 08-05-2020 Remunerasi insentif pegawai a/n 749,048.00 92,546,140.92
Cicik Sri W
30 08-05-2020 Remunerasi isentif pegawai a/n 5.2.2.26.01 773,253.00 91,772,887.92
Zully K
31 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 818,400.00 90,954,487.92
drg. Ami S
32 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 912,407.00 90,042,080.92
Riska Aprilia
33 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 912,949.00 89,129,131.92
Rosa Budi
34 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 935,126.00 88,194,005.92
Siti Windasari
35 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 935,126.00 87,258,879.92
Arif basuki
36 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 941,618.00 86,317,261.92
Sulastri
37 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 949,326.00 85,367,935.92
Nanik isnaiani
38 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 949,326.00 84,418,609.92
Chusnul chotimah

39 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 949,326.00 83,469,283.92


Nurdiana Dwi K
40 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 963,525.00 82,505,758.92
Siti Pattimah
NO. KODE
NO. TGL BUKTI
URAIAN REKENING
REF PENERIMAAN PENGELUARAN SALDO
41 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 966,636.00 81,539,122.92
Umi Sholikah
42 08-05-2020 Remunerasi insentif pegawai a/n Sri 5.2.2.26.01 977,725.00 80,561,397.92
astutik
43 08-05-2020 Remunerasi insentif pegawai a/n Tri 5.2.2.26.01 991,924.00 79,569,473.92
W
44 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 991,924.00 78,577,549.92
Nikmatun K
45 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 996,435.00 77,581,114.92
Siti sahidatun
46 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 1,029,346.00 76,551,768.92
Asna Rofiko
47 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 1,039,034.00 75,512,734.92
Elik Junaidah
48 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 1,062,921.00 74,449,813.92
Nur Choiriyah
49 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 1,077,120.00 73,372,693.92
Siti Choiriyah
50 08-05-2020 Remunerasi insentif pegawai a/n 1,087,938.00 72,284,755.92
Elfrida W
51 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 1,087,938.00 71,196,817.92
Kamala M
52 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 1,133,918.00 70,062,899.92
Niken K
53 08-05-2020 Remunerasi insentif pegawai a/n Tri 5.2.2.26.01 1,161,775.00 68,901,124.92
istina
54 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 1,292,951.00 67,608,173.92
Slamet Pujianto
55 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 1,428,670.00 66,179,503.92
Tusy Novita
56 08-05-2020 Belanja kantong puyer bln Mrt 5.2.2.26.01 2,250,000.00 63,929,503.92

57 08-05-2020 Remuerasi insentif pegawai a/n drg. 5.2.2.26.01 3,025,269.00 60,904,234.92


Amis S
58 09-05-2020 Laboratorium 4.1.2.01.17 47,000.00 60,951,234.92
59 09-05-2020 Administrasi Karcis 4.1.2.01.11 55,000.00 61,006,234.92
60 11-05-2020 Administrasi Karcis 4.1.2.01.11 65,000.00 61,071,234.92
61 11-05-2020 Laboratorium 4.1.2.01.17 140,000.00 61,211,234.92
62 12-05-2020 Administrasi Karcis 4.1.2.01.11 75,000.00 61,286,234.92
63 12-05-2020 Penarikan tunai (kurang bayar rek. 5.2.2.26.01 45,000.00 61,241,234.92
Telepn bln April)
64 12-05-2020 Penarikan tunak (rek listrik, 5.2.2.26.01 1,363,065.00 59,878,169.92
telepon, internet bln Mei)
65 13-05-2020 Administrasi Karcis 4.1.2.01.11 30,000.00 59,908,169.92
66 13-05-2020 Administrasi Karcis 4.1.2.01.11 30,000.00 59,938,169.92
67 13-05-2020 Laboratorium 4.1.2.01.17 140,000.00 60,078,169.92
68 14-05-2020 Laboratorium 4.1.2.01.17 15,000.00 60,093,169.92
69 14-05-2020 Administrasi Karcis 4.1.2.01.11 60,000.00 60,153,169.92
70 14-05-2020 Bayar cek 25 lbr 5.2.2.26.01 50,000.00 60,103,169.92
71 14-05-2020 Bayar tera cek 25 lbr 5.2.2.26.01 75,000.00 60,028,169.92
72 15-05-2020 Administrasi Karcis 4.1.2.01.11 20,000.00 60,048,169.92
73 15-05-2020 Diterima kap. Susulan April & kap. 55,194,200.00 115,242,369.92
Susulan Mei
74 16-05-2020 Tindakan / Operasi 4.1.2.01.12 10,000.00 115,252,369.92
75 16-05-2020 Laboratorium 4.1.2.01.17 10,000.00 115,262,369.92
76 16-05-2020 Administrasi Karcis 4.1.2.01.11 45,000.00 115,307,369.92
77 18-05-2020 Administrasi Karcis 4.1.2.01.11 90,000.00 115,397,369.92
78 18-05-2020 Laboratorium 4.1.2.01.17 247,000.00 115,644,369.92
79 19-05-2020 Tindakan / Operasi 4.1.2.01.12 10,000.00 115,654,369.92
80 19-05-2020 Administrasi Karcis 4.1.2.01.11 55,000.00 115,709,369.92
81 19-05-2020 Laboratorium 4.1.2.01.17 149,000.00 115,858,369.92
82 20-05-2020 Laboratorium 4.1.2.01.17 34,000.00 115,892,369.92
83 20-05-2020 Administrasi Karcis 4.1.2.01.11 90,000.00 115,982,369.92
84 20-05-2020 Belanja perlengkapan komputer 5.2.2.26.01 1,950,000.00 114,032,369.92
NO. KODE
NO. TGL BUKTI
URAIAN REKENING
REF PENERIMAAN PENGELUARAN SALDO
85 22-05-2020 Administrasi Karcis 4.1.2.01.11 65,000.00 114,097,369.92
86 22-05-2020 Laboratorium 4.1.2.01.17 81,000.00 114,178,369.92
87 23-05-2020 Administrasi Karcis 4.1.2.01.11 20,000.00 114,198,369.92
88 23-05-2020 Disetor pajak atas belanja HT 484,881.00 113,713,488.92
Radiomedik
89 23-05-2020 Belanja kantong plastik 5.2.2.26.01 487,500.00 113,225,988.92
90 23-05-2020 Disetor pajak atas belanja HT 624,659.00 112,601,329.92
Radiomedik
91 23-05-2020 Belanja HT Radiomedik 5.2.3.27.04 4,153,119.00 108,448,210.92
92 23-05-2020 Belanja HT Radiomedik 5.2.3.27.04 5,350,341.00 103,097,869.92
93 26-05-2020 Laboratorium 4.1.2.01.17 55,000.00 103,152,869.92
94 26-05-2020 Administrasi Karcis 4.1.2.01.11 100,000.00 103,252,869.92
95 26-05-2020 Belanja fotokopi bln April 5.2.2.26.01 150,000.00 103,102,869.92
96 26-05-2020 Belanja alat listrik bln April 5.2.2.26.01 222,100.00 102,880,769.92
97 26-05-2020 Belanja alat kebersihan bln April 5.2.2.26.01 427,800.00 102,452,969.92

98 26-05-2020 Belanja ATK bln April 5.2.2.26.01 2,759,000.00 99,693,969.92


99 27-05-2020 Laboratirum 4.1.2.01.17 47,000.00 99,740,969.92
100 27-05-2020 Administrasi Karcis 4.1.2.01.11 60,000.00 99,800,969.92
101 27-05-2020 Administrasi Karcis 4.1.2.01.11 65,000.00 99,865,969.92
102 28-05-2020 Administrasi Karcis 4.1.2.01.11 105,000.00 99,970,969.92
103 29-05-2020 Retribusi Kekayaan Daerah 4.1.2.01.01 25,000.00 99,995,969.92
104 29-05-2020 Laboratorium 4.1.2.01.17 94,000.00 100,089,969.92
105 29-05-2020 Belanja perjadin posko covid April- 50,000.00 100,039,969.92
Mei a/n Tri Istina
106 29-05-2020 Belanja perjadin rapat dinas bln 50,000.00 99,989,969.92
April a/n Siti Syahidatun
107 29-05-2020 Belanja perjadin rapat dinas bln 5.2.2.26.01 100,000.00 99,889,969.92
April-Mei a/n Elfrida W
108 29-05-2020 Belanja perjadin rapat dinas a/n 5.2.2.26.01 100,000.00 99,789,969.92
Sulastri
109 29-05-2020 Belanja perjadin luar daerah a/n dr. 5.2.2.26.01 100,000.00 99,689,969.92
Tusy Novita
110 29-05-2020 Belanja fotokopi bln Mei 5.2.2.26.01 150,000.00 99,539,969.92
111 29-05-2020 Belanja perjadin posko covid April- 200,000.00 99,339,969.92
Mei a/n Arif B
112 29-05-2020 Belanja perlengkapan kantor 5.2.2.26.01 202,350.00 99,137,619.92
(papan tulis)
113 29-05-2020 Belanja alat listri bln Mei 5.2.2.26.01 217,200.00 98,920,419.92
114 29-05-2020 Belanja perjadin rapat dinas dan 5.2.2.26.01 300,000.00 98,620,419.92
Posko Covid bln April-Mei a/n Zully
K

115 29-05-2020 Belanja BBm Pusling bln Mei 5.2.2.26.01 300,000.00 98,320,419.92
116 29-05-2020 Belanja perjadin Posko Covid bln 5.2.2.26.01 350,000.00 97,970,419.92
April-Mei a/n Riska A
117 29-05-2020 Belanja perjadin rapat dinas dan 5.2.2.26.01 400,000.00 97,570,419.92
Posko Covid bln April-Mei a/n
Kamala M

118 29-05-2020 Belanja perjadin luar daerah a/n 5.2.2.26.01 400,000.00 97,170,419.92
drg. Ami S
119 29-05-2020 Belanja alat pembersih kantor bln 5.2.2.26.01 428,100.00 96,742,319.92
Mei
120 29-05-2020 Belanja perjadin Covid bln April- 5.2.2.26.01 500,000.00 96,242,319.92
Mei a/n Tri Wahyudi
121 29-05-2020 Belanja perjadin Posko Covid bln 5.2.2.26.01 600,000.00 95,642,319.92
April-Mei a/n elik Junaidah

122 29-05-2020 Belanja ATK bln Mei 5.2.2.26.01 3,416,600.00 92,225,719.92


123 29-05-2020 Belanja perlengkapan kantor 5.2.2.26.01 3,864,000.00 88,361,719.92
(korden)
124 30-05-2020 Laboratorium 4.1.2.01.17 10,000.00 88,371,719.92
125 30-05-2020 Administrasi Karcis 4.1.2.01.11 45,000.00 88,416,719.92
126 88,416,719.92
127 88,416,719.92
NO. KODE
NO. TGL BUKTI
URAIAN REKENING
REF PENERIMAAN PENGELUARAN SALDO
128 88,416,719.92
129 88,416,719.92
130 88,416,719.92
131 88,416,719.92
132 88,416,719.92
133 88,416,719.92
134 88,416,719.92
135 88,416,719.92
136 88,416,719.92
137 88,416,719.92
138 88,416,719.92
139 88,416,719.92
140 88,416,719.92
141 88,416,719.92
142 88,416,719.92
143 88,416,719.92
144 88,416,719.92
145 88,416,719.92
146 88,416,719.92
147 88,416,719.92
148 88,416,719.92
149 88,416,719.92
150 88,416,719.92
151 88,416,719.92
152 88,416,719.92
153 88,416,719.92
154 88,416,719.92
155 88,416,719.92
156 88,416,719.92
157 88,416,719.92
158 88,416,719.92
159 88,416,719.92
160 88,416,719.92
161 88,416,719.92
162 88,416,719.92
163 88,416,719.92
164 88,416,719.92
165 88,416,719.92
166 88,416,719.92
167 88,416,719.92
168 88,416,719.92
169 88,416,719.92
170 88,416,719.92
171 88,416,719.92
172 88,416,719.92
173 88,416,719.92
174 88,416,719.92
175 88,416,719.92
176 88,416,719.92
177 88,416,719.92
178 88,416,719.92
179 88,416,719.92
180 88,416,719.92
181 88,416,719.92
182 88,416,719.92
183 88,416,719.92
184 88,416,719.92
185 88,416,719.92
NO. KODE
NO. TGL BUKTI
URAIAN REKENING
REF PENERIMAAN PENGELUARAN SALDO
186 88,416,719.92
187 88,416,719.92
188 88,416,719.92
189 88,416,719.92
190 88,416,719.92
191 88,416,719.92
192 88,416,719.92
193 88,416,719.92
194 88,416,719.92
195 88,416,719.92
196 88,416,719.92
197 88,416,719.92
198 88,416,719.92
199 88,416,719.92
200 88,416,719.92
201 88,416,719.92
202 88,416,719.92
203 88,416,719.92
204 88,416,719.92
205 88,416,719.92
206 88,416,719.92
207 88,416,719.92
208 88,416,719.92
209 88,416,719.92
210 88,416,719.92
211 88,416,719.92
212 88,416,719.92
213 88,416,719.92
214 88,416,719.92
215 88,416,719.92
216 88,416,719.92
217 88,416,719.92
218 88,416,719.92
219 88,416,719.92
220 88,416,719.92
221 88,416,719.92
222 88,416,719.92
223 88,416,719.92
224 88,416,719.92
225 88,416,719.92
226 88,416,719.92
227 88,416,719.92
228 88,416,719.92
229 88,416,719.92
230 88,416,719.92
231 88,416,719.92
232 88,416,719.92
233 88,416,719.92
234 88,416,719.92
235 88,416,719.92
236 88,416,719.92
237 88,416,719.92
238 88,416,719.92
239 88,416,719.92
240 88,416,719.92
241 88,416,719.92
242 88,416,719.92
243 88,416,719.92
NO. KODE
NO. TGL BUKTI
URAIAN REKENING
REF PENERIMAAN PENGELUARAN SALDO
244 88,416,719.92
245 88,416,719.92
246 88,416,719.92
247 88,416,719.92
248 88,416,719.92
249 88,416,719.92
250 88,416,719.92
251 88,416,719.92
252 88,416,719.92
253 88,416,719.92
254 88,416,719.92
255 88,416,719.92
256 88,416,719.92
257 88,416,719.92
258 88,416,719.92
259 88,416,719.92
260 88,416,719.92
261 88,416,719.92
262 88,416,719.92
263 88,416,719.92
264 88,416,719.92
265 88,416,719.92
266 88,416,719.92
267 88,416,719.92
268 88,416,719.92
269 88,416,719.92
270 88,416,719.92
271 88,416,719.92
272 88,416,719.92
273 88,416,719.92
274 88,416,719.92
275 88,416,719.92
276 88,416,719.92
277 88,416,719.92
278 88,416,719.92
279 88,416,719.92
280 88,416,719.92
281 88,416,719.92
282 88,416,719.92
283 88,416,719.92
284 88,416,719.92
285 88,416,719.92
286 88,416,719.92
287 88,416,719.92
288 88,416,719.92
289 88,416,719.92
290 88,416,719.92
291 88,416,719.92
292 88,416,719.92
293 88,416,719.92
294 88,416,719.92
295 88,416,719.92
296 88,416,719.92
297 88,416,719.92
298 88,416,719.92
299 88,416,719.92
300 88,416,719.92
301 88,416,719.92
NO. KODE
NO. TGL BUKTI
URAIAN REKENING
REF PENERIMAAN PENGELUARAN SALDO
302 88,416,719.92
303 88,416,719.92
304 88,416,719.92
305 88,416,719.92
306 88,416,719.92
307 88,416,719.92
308 88,416,719.92
309 88,416,719.92
310 88,416,719.92
311 88,416,719.92
312 88,416,719.92
313 88,416,719.92
314 88,416,719.92
315 88,416,719.92
316 88,416,719.92
317 88,416,719.92
318 88,416,719.92
319 88,416,719.92
320 88,416,719.92
321 88,416,719.92
322 88,416,719.92
323 88,416,719.92
324 88,416,719.92
325 88,416,719.92
326 88,416,719.92
327 88,416,719.92
328 88,416,719.92
329 88,416,719.92
330 88,416,719.92
331 88,416,719.92
332 88,416,719.92
333 88,416,719.92
334 88,416,719.92
335 88,416,719.92
336 88,416,719.92
337 88,416,719.92
338 88,416,719.92
339 88,416,719.92
340 88,416,719.92
341 88,416,719.92
342 88,416,719.92
343 88,416,719.92
344 88,416,719.92
345 88,416,719.92
346 88,416,719.92
347 88,416,719.92
348 88,416,719.92
349 88,416,719.92
350 88,416,719.92
351 88,416,719.92
352 88,416,719.92
353 88,416,719.92
354 88,416,719.92
355 88,416,719.92
356 88,416,719.92
357 88,416,719.92
358 88,416,719.92
359 88,416,719.92
NO. KODE
NO. TGL BUKTI
URAIAN REKENING
REF PENERIMAAN PENGELUARAN SALDO
360 88,416,719.92
361 88,416,719.92
362 88,416,719.92
363 88,416,719.92
364 88,416,719.92
365 88,416,719.92
366 88,416,719.92
367 88,416,719.92
368 88,416,719.92
369 88,416,719.92
370 88,416,719.92
371 88,416,719.92
372 88,416,719.92
373 88,416,719.92
374 88,416,719.92
375 88,416,719.92
376 88,416,719.92
377 88,416,719.92
378 88,416,719.92
379 88,416,719.92
380 88,416,719.92
381 88,416,719.92
382 88,416,719.92
383 88,416,719.92
384 88,416,719.92
385 88,416,719.92
386 88,416,719.92
387 88,416,719.92
388 88,416,719.92
389 88,416,719.92
390 88,416,719.92
391 88,416,719.92
392 88,416,719.92
393 88,416,719.92
394 88,416,719.92
395 88,416,719.92
396 88,416,719.92
397 88,416,719.92
398 88,416,719.92
399 88,416,719.92
400 88,416,719.92
401 88,416,719.92
402 88,416,719.92
403 88,416,719.92
404 88,416,719.92
405 88,416,719.92
406 88,416,719.92
407 88,416,719.92
408 88,416,719.92
409 88,416,719.92
410 88,416,719.92
411 88,416,719.92
412 88,416,719.92
413 88,416,719.92
414 88,416,719.92
415 88,416,719.92
416 88,416,719.92
417 88,416,719.92
NO. KODE
NO. TGL BUKTI
URAIAN REKENING
REF PENERIMAAN PENGELUARAN SALDO
418 88,416,719.92
419 88,416,719.92
420 88,416,719.92
421 88,416,719.92
422 88,416,719.92
423 88,416,719.92
424 88,416,719.92
425 88,416,719.92
426 88,416,719.92
427 88,416,719.92
428 88,416,719.92
429 88,416,719.92
430 88,416,719.92
431 88,416,719.92
432 88,416,719.92
433 88,416,719.92
434 88,416,719.92
435 88,416,719.92
436 88,416,719.92
437 88,416,719.92
438 88,416,719.92
439 88,416,719.92
440 88,416,719.92
441 88,416,719.92
442 88,416,719.92
443 88,416,719.92
444 88,416,719.92
445 88,416,719.92
446 88,416,719.92
447 88,416,719.92
448 88,416,719.92
449 88,416,719.92
450 88,416,719.92
451 88,416,719.92
452 88,416,719.92
453 88,416,719.92
454 88,416,719.92
455 88,416,719.92
456 88,416,719.92
457 88,416,719.92
458 88,416,719.92
459 88,416,719.92
460 88,416,719.92
461 88,416,719.92
462 88,416,719.92
463 88,416,719.92
464 88,416,719.92
465 88,416,719.92
466 88,416,719.92
467 88,416,719.92
468 88,416,719.92
469 88,416,719.92
470 88,416,719.92
471 88,416,719.92
472 88,416,719.92
473 88,416,719.92
474 88,416,719.92
475 88,416,719.92
NO. KODE
NO. TGL BUKTI
URAIAN REKENING
REF PENERIMAAN PENGELUARAN SALDO
476 88,416,719.92
477 88,416,719.92
478 88,416,719.92
479 88,416,719.92
480 88,416,719.92
481 88,416,719.92
482 88,416,719.92
483 88,416,719.92
484 88,416,719.92
485 88,416,719.92
486 88,416,719.92
487 88,416,719.92
488 88,416,719.92
489 88,416,719.92
490 88,416,719.92
491 88,416,719.92
492 88,416,719.92
493 88,416,719.92
494 88,416,719.92
495 88,416,719.92
496 88,416,719.92
497 88,416,719.92
498 88,416,719.92
499 88,416,719.92
500 88,416,719.92

Jumlah periode ini 58,346,737.92 89,549,915.00 88,416,719.92


-1 01-01-2020 Jumlah sampai periode lalu
Jumlah semua sampai periode ini 58,346,737.92 89,549,915.00 88,416,719.92
Sisa Kas 88,416,719.92 Tuli
se
Kas di Bendahara Penerimaan Rp.88.416.719,92,-
( Dua Ratus Tiga Puluh Tiga Juta Tujuh Ratus Enam Puluh Empat Ribu Dua Ratus Sepuluh Rupiah Ssembilan
Puluh Dua Sen )

terdiri dari :
a. Tunai Rp 335,000.00.-
b. Saldo Bank Rp 88,081,719.92.-

Mengetahui Jombang, 31-05-2020


Kepala BLUD Bendahara Penerimaan
Puskesmas Jatiwates

drg.AMI SETYANINGRUM
Nip.197509262014122001
PEMERINTAH KABUPATEN JOMBANG
DINAS KESEHATAN
BLUD PUSKESMAS JATIWATES
Jl. Seruni No. 02 Ds. Jatiwates Kec. Tembelang Kab. Jombang
Kode Pos: 61452 Telp. (0321) 883817 Email: pjatiwates@gmail.com
0

REGISTER PENUTUPAN KAS


Tanggal Penutupan kas : 31 Mei 2020
Nama Penutup Kas : Sulastri
Tanggal Penutupan kas Yang lalu :
Jumlah Transaksi s/d bulan ini
Jumlah penerimaan s/d tanggal 31 Mei 2020 : Rp. 58,346,737.92
Jumlah Pengeluaran s/d tanggal 31 Mei 2020 : Rp. 89,549,915.00
Saldo Buku : -Rp 31,203,177.08
Saldo Kas : Rp. 935,954,305.54

Terdiri atas :
1 Uang Kertas :
Pecahan 100000 = 3 lembar : Rp. 300,000.00
Pecahan 50000 = lembar : Rp -
Pecahan 20000 = lembar : Rp -
Pecahan 10000 = 3 lembar : Rp. 30,000.00
Pecahan 5000 = 1 lembar : Rp. 5,000.00
Pecahan 2000 = lembar : Rp -
Pecahan 1000 = lembar : Rp -

2 Uang Logam :

Pecahan 1000 = keping : Rp -

Pecahan 500 = keping : Rp -

Pecahan 200 = keping : Rp -

Pecahan 100 = keping : Rp -

Pecahan 50 = keping : Rp -

Pecahan 25 = keping : Rp -

3 : Rp. 935,619,305.54
Kertas berharga dan bagian kas yang diizinkan
ordonasi/SP2D, Wesel, Cek, Saldo Bank, Materai,
dan sebagainya

4 Jumlah : Rp. 935,954,305.54

Selisih : -Rp 967,157,482.62

Penjelasan perbedaan baik positif maupun negatif :


Adanya perbedaan saldo buku dan saldo kas sebesar -
Rp.967.157.482,62,- terdiri dari silva Tahun Anggaran 2019 yang
belum diakui dan belum dicatat Sebagai Pembiayaan Penerimaan
Kode Pos: 61452 Telp. (0321) 883817 Email: pjatiwates@gmail.com
0

Mengetahui Pejabat Keuangan BLUD


PEMERINTAH KABUPATEN JOMBANG
BLUD PUSKESMAS JATIWATES
LAPORAN PENDAPATAN, BELANJA, DAN PEMBIAYAAN
BULAN MEI TAHUN ANGGARAN 2020
Jumlah (Rp) Bertambah/(berkurang)
No Uraian Anggaran dalam Realisasi s/d Realisasi Bulan Realisasi s/d
Rp %
DPA Bulan lalu ini Bulan ini
1 2 3 4 5 6=(4+5) 7=(3-5 8=(6/3)x100
PENDAPATAN 867,100,189.00 537,044,200.00 3,152,537.92 540,196,737.92 863,947,651.08 62.30
Jasa Layanan 72,335,000.00 2,923,000.00 75,258,000.00 (2,923,000.00)
Sewa Kekayaan Daerah - - -
Kapitasi BPJS 461,656,100.00 - 461,656,100.00 -
Non Kapitasi -
Prolanis 3,053,100.00 - 3,053,100.00 -
Hibah - - -
Hasil Kerja Sama - - -
Pendapatan BLUD yang sah - - -
Bunga 229,537.92 229,537.92 (229,537.92)
Jumlah - 537,044,200.00 3,152,537.92 540,196,737.92 (3,152,537.92)
BELANJA - -
BELANJA OPERASI - 318,480,087.00 56,739,929.00 375,220,016.00 (56,739,929.00)
Belanja Pegawai 600,000.00 600,000.00 (600,000.00)
Belanja Barang dan Jasa 318,480,087.00 56,139,929.00 374,620,016.00 (56,139,929.00)
Belanja Bunga - - -
Belanja lain-lain - - -
BELANJA MODAL - - 22,563,460.00 22,563,460.00 (22,563,460.00)
Belanja Tanah - -
Belanja Peralatan dan Mesin - -
Belanja Gedung dan Bangunan - -

Belanja Jalan, Irigasi, dan Jaringan - -

Belanja Aset Tetap Lainnya - -


Belanja Aset Lainnya - -
Jumlah (Rp) Bertambah/(berkurang)
No Uraian Anggaran dalam Realisasi s/d Realisasi Bulan Realisasi s/d
Rp %
DPA Bulan lalu ini Bulan ini
1 2 3 4 5 6=(4+5) 7=(3-5 8=(6/3)x100
Jumlah - 318,480,087.00 79,303,389.00 397,783,476.00 (79,303,389.00)
PEMBIAYAAN - -
PENERIMAAN PEMBIAYAAN - -

Penggunaan Sisa Lebih Perhitungan


- -
Anggaran Tahun Sebelumnya (SILPA)

Divestasi - -
Penerimaan Utang/Pinjaman - -
Jumlah - - - - -
PENGELUARAN PEMBIAYAAN - -
Investasi - -

Pembayaran Pokok Utang/Pinjaman - -

Jumlah - - - - -
Pembiayaan Netto - - - - -

Sisa Lebih Pembiayaan Anggaran


- -
Tahun Berkenaan (SiLPA)

Jombang,
Mengetahui Pejabat Keuangan BLUD
Kepala BLUD Puskesmas Jatiwates Puskesmas Jatiwates

drg.AMI SETYANINGRUM Sulastri


NIP.197509262014122001 Nip.196608271988032006
PEMERINTAH KABUPATEN JOMBANG
DINAS KESEHATAN
BLUD PUSKESMAS JATIWATES
Jl. Seruni No. 02 Ds. Jatiwates Kec. Tembelang Kab. Jombang
Kode Pos: 61452 Telp. (0321) 883817 Email: pjatiwates@gmail.com
0

SURAT PERMINTAAN PENGESAHAN PENDAPATAN DAN


BELANJA (SP3B)

Agar tercipta tertib administrasi pengelolaan keuangan BLUD Puskesmas


Jatiwates Kabupaten Jombang , maka bersama ini kami kirimkan Surat
Permintaan Pengesahan Pendapatan dan Belanja (SP3B) periode Bulan Mei 2020
Dengan Pendapatan Sebesar Rp.58.346.737,92,- (Lima Puluh Delapan Juta Tiga
Ratus Empat Puluh Enam Ribu Tujuh Ratus Tiga Puluh Tujuh Rupiah Sembilan
Puluh Dua Sen) dan Belanja Bulan Mei 2020 Sebesar Rp.89.549.915,00,- (Delapan
Puluh Sembilan Juta Lima Ratus Empat Puluh Sembilan Ribu Sembilan Ratus Lima
Belas Rupiah ).

Berkaitan dengan hal tersebut, dimohon Kepala BPKAD Kabupaten


Jombang selaku BUD untuk menerbitkan Surat Pengesahan Pendapatan dan
Belanja (SP2B) bagi BLUD Puskesmas Jatiwates Kabupaten Jombang.

Demikian atas perhatian dan kerjasamanya disampaikan terima kasih.

Jombang, 06-06-2020
Kepala BLUD Puskesmas Jatiwates
Kabupaten Jombang.

drg.AMI SETYANINGRUM
Penata
NIP.197509262014122001
PEMERINTAH KABUPATEN JOMBANG
DINAS KESEHATAN
BLUD PUSKESMAS JATIWATES
Jl. Seruni No. 02 Ds. Jatiwates Kec. Tembelang Kab. Jombang
Kode Pos: 61452 Telp. (0321) 883817 Email: pjatiwates@gmail.com
0

Jombang, 06-06-2020
Kepada
Yth. Kepala BPKAD Kabupaten Jombang
Nomor : 900/ /415.17.11 /2020 Melalui Kepala Dinas Kesehatan
Sifat : Penting Kabupaten Jombang
Lampiran : di
Perihal : Permintaan Pengesahan JOMBANG
Pendapatan Belanja Mei
2020

Bersama ini kami kirimkan Laporan Realisasi Anggaran BLUD


Puskesmas Jatiwates untuk disahkan sebagai Pendapatan dan Belanja
Bulan Mei 2020.

Atas perhatian dan kerjasamanya disampaikan terima kasih.

Jombang,
Kepala BLUD
Puskesmas Jatiwates

drg.AMI SETYANINGRUM
Penata
NIP.197509262014122001
PEMERINTAH KABUPATEN JOMBANG
DINAS KESEHATAN
BLUD PUSKESMAS JATIWATES
Jl. Seruni No. 02 Ds. Jatiwates Kec. Tembelang Kab. Jombang
Kode Pos: 61452 Telp. (0321) 883817 Email: pjatiwates@gmail.com
0

SURAT PERNYATAAN TANGGUNG JAWAB (SPTJ)

Nama Badan Layanan Umum Daerah : Puskesmas Jatiwates


Kode Organisasi : 415.17.11
Nomor/tanggal DPA SKPD : 1.02.63.012
Kegiatan : BLUD Puskesmas Tembelang

Yang bertandatangan dibawah ini drg.AMI SETYANINGRUM. Menyatakan


bahwa saya bertanggungjawab atas semua realisasi pendapatan yang telah diterima
sebesar Rp.58.346.737,92,- (Lima Puluh Delapan Juta Tiga Ratus Empat Puluh
Enam Ribu Tujuh Ratus Tiga Puluh Tujuh Rupiah Sembilan Puluh Dua Sen) dan
belanja sebesar Rp.89.549.915,00,- (Delapan Puluh Sembilan Juta Lima Ratus
Empat Puluh Sembilan Ribu Sembilan Ratus Lima Belas Rupiah ). yang telah
dibayar kepada yang berhak menerima serta pembiayaan, yang dananya bersumber
dari Jasa Layanan, Hibah, Hasil Kerja Sama dan lain-lain pendapatan BLUD yang
sah dan digunakan langsung pada bulan Mei tahun anggaran 2020 (Laporan
realisasi pendapatan, belanja dan pembiayaan terlampir).

Bukti-bukti pendapatan, belanja dan pembiayaan di atas disimpan Sesuai


dengan ketentuan yang berlaku untuk kelengkapan administrasi dan keperluan
pemeriksaan aparat pengawas. Apabila di kemudian hari terjadi kerugian daerah,
saya bersedia bertanggungjawab sepenuhnya atas kerugian daerah dimaksud dan
dapat dituntut penggantian sesuai dengan ketentuan peraturan perundang-
undangan.

Demikian Surat Pernyataan ini dibuat dengan sebenarnya, untuk


mendapatkan pengesahan realisasi pendapatan, belanja dan pembiayaan.

Jombang, 06-06-2020
Kepala BLUD
Puskesmas Jatiwates

meterai
6000

drg.AMI SETYANINGRUM
Penata
NIP.197509262014122001
PEMERINTAH KABUPATEN JOMBANG
DINAS KESEHATAN
BLUD PUSKESMAS JATIWATES
Jl. Seruni No. 02 Ds. Jatiwates Kec. Tembelang Kab. Jombang
Kode Pos: 61452 Telp. (0321) 883817 Email: pjatiwates@gmail.com
0

Jombang, 06-06-2020
Nomor : 900/ /415.17.11 /2020 Kepada
Sifat : Penting Yth. Kepala BPKAD Kabupaten Jombang
di
JOMBANG

SURAT PENGANTAR

NO JENIS YANG DIKIRIM BANYAKNYA KETERANGAN


1 Pengajuan Pengesahan 1 Bendel Dikirim dengan hormat untuk
Pendapatan Belanja menjadikan periksa
Bulan Mei 2020 Terdiri
dari :

a Surat Permintaan
Pengesahan SP3B
b Surat Pernyataan
Tanggung Jawab (SPTJ)
c SP3B dari Aplikasi Simda

d Laporan Realisasi
Pendapatan dan Belanja
Sesuai RBA
e BKU
f Register Penutupan Kas
g Rekening Koran.

Diterima Tgl : …....... Pengirim


Penerima, Kepala BLUD
Puskesmas Jatiwates

drg.AMI SETYANINGRUM
Nip. Penata
NIP.197509262014122001
PEMERINTAH KABUPATEN JOMBANG
BUKU KAS UMUM
BLUD PUSKESMAS JATIWATES
periode : 01 Mei 2020 s/d 31 Mei 2020

NO. KODE
NO. TGL BUKTI
URAIAN REKENING
REF PENERIMAAN PENGELUARAN SALDO
1 Saldo Bulan Lalu -
2 01-05-2020 Bunga Bank 4.1.4.20 229,537.92 229,537.92
3 01-05-2020 Setor ke BLUD PKM Jatiwates sts 37 229,537.92 -

4 02-05-2020 Administrasi Karcis 4.1.2.01.11 95,000.00 95,000.00


5 02-05-2020 Tindakan / Operasi 4.1.2.01.12 10,000.00 105,000.00
6 02-05-2020 Laboratorium 4.1.2.01.17 110,000.00 215,000.00
7 04-05-2020 Administrasi Karcis 4.1.2.01.11 60,000.00 275,000.00
8 04-05-2020 Laboratorium 4.1.2.01.17 50,000.00 325,000.00
9 04-05-2020 Setor ke BLUD PKM Jatiwates sts 38 325,000.00 -
10 05-05-2020 Administrasi Karcis 4.1.2.01.11 60,000.00 60,000.00
11 05-05-2020 Laboratorium 4.1.2.01.17 122,000.00 182,000.00
12 06-05-2020 Administrasi Karcis 4.1.2.01.11 80,000.00 262,000.00
13 06-05-2020 Laboratorium 4.1.2.01.17 47,000.00 309,000.00
14 06-05-2020 Setor ke BLUD PKM Jatiwates sts 39 309,000.00 -
15 08-05-2020 Administrasi Karcis 4.1.2.01.11 100,000.00 100,000.00
16 09-05-2020 Administrasi Karcis 4.1.2.01.11 55,000.00 155,000.00
17 09-05-2020 Laboratorium 4.1.2.01.17 47,000.00 202,000.00
18 11-05-2020 Administrasi Karcis 4.1.2.01.11 65,000.00 267,000.00
19 11-05-2020 Laboratorium 4.1.2.01.17 140,000.00 407,000.00
20 12-05-2020 Setor ke BLUD PKM Jatiwates sts 40 407,000.00 -

21 12-05-2020 Administrasi Karcis 4.1.2.01.11 75,000.00 75,000.00


22 13-05-2020 Administrasi Karcis 4.1.2.01.11 30,000.00 105,000.00
23 13-05-2020 Laboratorium 4.1.2.01.17 140,000.00 245,000.00
24 13-05-2020 Administrasi Karcis 4.1.2.01.11 30,000.00 275,000.00
25 14-05-2020 Administrasi Karcis 4.1.2.01.11 60,000.00 335,000.00
26 14-05-2020 Laboratorium 4.1.2.01.17 15,000.00 350,000.00
27 14-05-2020 Setor ke BLUD PKM Jatiwates sts 41 350,000.00 -

28 15-05-2020 Administrasi Karcis 4.1.2.01.11 20,000.00 20,000.00


29 15-05-2020 Diterima kap. Susulan April & kap. 55,194,200.00 55,214,200.00
Susulan Mei
30 15-05-2020 Disetor ke PKM Jatiwates 55,194,200.00 20,000.00
31 16-05-2020 Administrasi Karcis 4.1.2.01.11 45,000.00 65,000.00
32 16-05-2020 Tindakan / Operasi 4.1.2.01.12 10,000.00 75,000.00
33 16-05-2020 Laboratorium 4.1.2.01.17 10,000.00 85,000.00
34 18-05-2020 Administrasi Karcis 4.1.2.01.11 90,000.00 175,000.00
35 18-05-2020 Laboratorium 4.1.2.01.17 247,000.00 422,000.00
36 19-05-2020 Administrasi Karcis 4.1.2.01.11 55,000.00 477,000.00
37 19-05-2020 Tindakan / Operasi 4.1.2.01.12 10,000.00 487,000.00
38 19-05-2020 Laboratorium 4.1.2.01.17 149,000.00 636,000.00
39 20-05-2020 Administrasi Karcis 4.1.2.01.11 90,000.00 726,000.00
40 20-05-2020 Laboratorium 4.1.2.01.17 34,000.00 760,000.00
41 20-05-2020 Setor ke PKM Jatiwates sts 42 760,000.00 -
42 22-05-2020 Administrasi Karcis 4.1.2.01.11 65,000.00 65,000.00
43 22-05-2020 Laboratorium 4.1.2.01.17 81,000.00 146,000.00
44 23-05-2020 Administrasi Karcis 4.1.2.01.11 20,000.00 166,000.00
45 26-05-2020 Administrasi Karcis 4.1.2.01.11 100,000.00 266,000.00
46 26-05-2020 Laboratorium 4.1.2.01.17 55,000.00 321,000.00
47 26-05-2020 Setor ke BLUD PKM Jatiwates 321,000.00 -
48 27-05-2020 Administrasi Karcis 4.1.2.01.11 65,000.00 65,000.00
49 27-05-2020 Laboratirum 4.1.2.01.17 47,000.00 112,000.00
50 27-05-2020 Administrasi Karcis 4.1.2.01.11 60,000.00 172,000.00
NO. KODE
NO. TGL BUKTI
URAIAN REKENING
REF PENERIMAAN PENGELUARAN SALDO
51 28-05-2020 Administrasi Karcis 4.1.2.01.11 105,000.00 277,000.00
52 29-05-2020 Laboratorium 4.1.2.01.17 94,000.00 371,000.00
53 29-05-2020 Retribusi Kekayaan Daerah 4.1.2.01.01 25,000.00 396,000.00
54 29-05-2020 Setor ke BLUD PKM Jatiwates sts 44 396,000.00 -

55 30-05-2020 Administrasi Karcis 4.1.2.01.11 45,000.00 45,000.00


56 30-05-2020 Laboratorium 4.1.2.01.17 10,000.00 55,000.00
57 55,000.00
58 55,000.00
59 55,000.00
60 55,000.00
61 55,000.00
62 55,000.00
63 55,000.00
64 55,000.00
65 55,000.00
66 55,000.00
67 55,000.00
68 55,000.00
69 55,000.00
70 55,000.00
71 55,000.00
72 55,000.00
73 55,000.00
74 55,000.00
75 55,000.00
76 55,000.00
77 55,000.00
78 55,000.00
79 55,000.00
80 55,000.00
81 55,000.00
82 55,000.00
83 55,000.00
84 55,000.00
85 55,000.00
86 55,000.00
87 55,000.00
88 55,000.00
89 55,000.00
90 55,000.00
91 55,000.00
92 55,000.00
93 55,000.00
94 55,000.00
95 55,000.00
96 55,000.00
97 55,000.00
98 55,000.00
99 55,000.00
100 55,000.00
101 55,000.00
102 55,000.00
103 55,000.00
104 55,000.00
105 55,000.00
106 55,000.00
107 55,000.00
108 55,000.00
NO. KODE
NO. TGL BUKTI
URAIAN REKENING
REF PENERIMAAN PENGELUARAN SALDO
109 55,000.00
110 55,000.00
111 55,000.00
112 55,000.00
113 55,000.00
114 55,000.00
115 55,000.00
116 55,000.00
117 55,000.00
118 55,000.00
119 55,000.00
120 55,000.00
121 55,000.00
122 55,000.00
123 55,000.00
124 55,000.00
125 55,000.00
126 55,000.00
127 55,000.00
128 55,000.00
129 55,000.00
130 55,000.00
131 55,000.00
132 55,000.00
133 55,000.00
134 55,000.00
135 55,000.00
136 55,000.00
137 55,000.00
138 55,000.00
139 55,000.00
140 55,000.00
141 55,000.00
142 55,000.00
143 55,000.00
144 55,000.00
145 55,000.00
146 55,000.00
147 55,000.00
148 55,000.00
149 55,000.00
150 55,000.00
151 55,000.00
152 55,000.00
153 55,000.00
154 55,000.00
155 55,000.00
156 55,000.00
157 55,000.00
158 55,000.00
159 55,000.00
160 55,000.00
161 55,000.00
162 55,000.00
163 55,000.00
164 55,000.00
165 55,000.00
166 55,000.00
NO. KODE
NO. TGL BUKTI
URAIAN REKENING
REF PENERIMAAN PENGELUARAN SALDO
167 55,000.00
168 55,000.00
169 55,000.00
170 55,000.00
171 55,000.00
172 55,000.00
173 55,000.00
174 55,000.00
175 55,000.00
176 55,000.00
177 55,000.00
178 55,000.00
179 55,000.00
180 55,000.00
181 55,000.00
182 55,000.00
183 55,000.00
184 55,000.00
185 55,000.00
186 55,000.00
187 55,000.00
188 55,000.00
189 55,000.00
190 55,000.00
191 55,000.00
192 55,000.00
193 55,000.00
194 55,000.00
195 55,000.00
196 55,000.00
197 55,000.00
198 55,000.00
199 55,000.00
200 55,000.00
201 55,000.00
202 55,000.00
203 55,000.00
204 55,000.00
205 55,000.00
206 55,000.00
207 55,000.00
208 55,000.00
209 55,000.00
210 55,000.00
211 55,000.00
212 55,000.00
213 55,000.00
214 55,000.00
215 55,000.00
216 55,000.00
217 55,000.00
218 55,000.00
219 55,000.00
220 55,000.00
221 55,000.00
222 55,000.00
223 55,000.00
224 55,000.00
NO. KODE
NO. TGL BUKTI
URAIAN REKENING
REF PENERIMAAN PENGELUARAN SALDO
225 55,000.00
226 55,000.00
227 55,000.00
228 55,000.00
229 55,000.00
230 55,000.00
231 55,000.00
232 55,000.00
233 55,000.00
234 55,000.00
235 55,000.00
236 55,000.00
237 55,000.00
238 55,000.00
239 55,000.00
240 55,000.00
241 55,000.00
242 55,000.00
243 55,000.00
244 55,000.00
245 55,000.00
246 55,000.00
247 55,000.00
248 55,000.00
249 55,000.00
250 55,000.00
251 55,000.00
252 55,000.00
253 55,000.00
254 55,000.00
255 55,000.00
256 55,000.00
257 55,000.00
258 55,000.00
259 55,000.00
260 55,000.00
261 55,000.00
262 55,000.00
263 55,000.00
264 55,000.00
265 55,000.00
266 55,000.00
267 55,000.00
268 55,000.00
269 55,000.00
270 55,000.00
271 55,000.00
272 55,000.00
273 55,000.00
274 55,000.00
275 55,000.00
276 55,000.00
277 55,000.00
278 55,000.00
279 55,000.00
280 55,000.00
281 55,000.00
282 55,000.00
NO. KODE
NO. TGL BUKTI
URAIAN REKENING
REF PENERIMAAN PENGELUARAN SALDO
283 55,000.00
284 55,000.00
285 55,000.00
286 55,000.00
287 55,000.00
288 55,000.00
289 55,000.00
290 55,000.00
291 55,000.00
292 55,000.00
293 55,000.00
294 55,000.00
295 55,000.00
296 55,000.00
297 55,000.00
298 55,000.00
299 55,000.00
300 55,000.00
301 55,000.00
302 55,000.00
303 55,000.00
304 55,000.00
305 55,000.00
306 55,000.00
307 55,000.00
308 55,000.00
309 55,000.00
310 55,000.00
311 55,000.00
312 55,000.00
313 55,000.00
314 55,000.00
315 55,000.00
316 55,000.00
317 55,000.00
318 55,000.00
319 55,000.00
320 55,000.00
321 55,000.00
322 55,000.00
323 55,000.00
324 55,000.00
325 55,000.00
326 55,000.00
327 55,000.00
328 55,000.00
329 55,000.00
330 55,000.00
331 55,000.00
332 55,000.00
333 55,000.00
334 55,000.00
335 55,000.00
336 55,000.00
337 55,000.00
338 55,000.00
339 55,000.00
340 55,000.00
NO. KODE
NO. TGL BUKTI
URAIAN REKENING
REF PENERIMAAN PENGELUARAN SALDO
341 55,000.00
342 55,000.00
343 55,000.00
344 55,000.00
345 55,000.00
346 55,000.00
347 55,000.00
348 55,000.00
349 55,000.00
350 55,000.00
351 55,000.00
352 55,000.00
353 55,000.00
354 55,000.00
355 55,000.00
356 55,000.00
357 55,000.00
358 55,000.00
359 55,000.00
360 55,000.00
361 55,000.00
362 55,000.00
363 55,000.00
364 55,000.00
365 55,000.00
366 55,000.00
367 55,000.00
368 55,000.00
369 55,000.00
370 55,000.00
371 55,000.00
372 55,000.00
373 55,000.00
374 55,000.00
375 55,000.00
376 55,000.00
377 55,000.00
378 55,000.00
379 55,000.00
380 55,000.00
381 55,000.00
382 55,000.00
383 55,000.00
384 55,000.00
385 55,000.00
386 55,000.00
387 55,000.00
388 55,000.00
389 55,000.00
390 55,000.00
391 55,000.00
392 55,000.00
393 55,000.00
394 55,000.00
395 55,000.00
396 55,000.00
397 55,000.00
398 55,000.00
NO. KODE
NO. TGL BUKTI
URAIAN REKENING
REF PENERIMAAN PENGELUARAN SALDO
399 55,000.00
400 55,000.00
401 55,000.00
402 55,000.00
403 55,000.00
404 55,000.00
405 55,000.00
406 55,000.00
407 55,000.00
408 55,000.00
409 55,000.00
410 55,000.00
411 55,000.00
412 55,000.00
413 55,000.00
414 55,000.00
415 55,000.00
416 55,000.00
417 55,000.00
418 55,000.00
419 55,000.00
420 55,000.00
421 55,000.00
422 55,000.00
423 55,000.00
424 55,000.00
425 55,000.00
426 55,000.00
427 55,000.00
428 55,000.00
429 55,000.00
430 55,000.00
431 55,000.00
432 55,000.00
433 55,000.00
434 55,000.00
435 55,000.00
436 55,000.00
437 55,000.00
438 55,000.00
439 55,000.00
440 55,000.00
441 55,000.00
442 55,000.00
443 55,000.00
444 55,000.00
445 55,000.00
446 55,000.00
447 55,000.00
448 55,000.00
449 55,000.00
450 55,000.00
451 55,000.00
452 55,000.00
453 55,000.00
454 55,000.00
455 55,000.00
456 55,000.00
NO. KODE
NO. TGL BUKTI
URAIAN REKENING
REF PENERIMAAN PENGELUARAN SALDO
457 55,000.00
458 55,000.00
459 55,000.00
460 55,000.00
461 55,000.00
462 55,000.00
463 55,000.00
464 55,000.00
465 55,000.00
466 55,000.00
467 55,000.00
468 55,000.00
469 55,000.00
470 55,000.00
471 55,000.00
472 55,000.00
473 55,000.00
474 55,000.00
475 55,000.00
476 55,000.00
477 55,000.00
478 55,000.00
479 55,000.00
480 55,000.00
481 55,000.00
482 55,000.00
483 55,000.00
484 55,000.00
485 55,000.00
486 55,000.00
487 55,000.00
488 55,000.00
489 55,000.00
490 55,000.00
491 55,000.00
492 55,000.00
493 55,000.00
494 55,000.00
495 55,000.00
496 55,000.00
497 55,000.00
498 55,000.00
499 55,000.00
500 55,000.00

Jumlah periode ini 58,346,737.92 58,291,737.92 55,000.00


-1 01-01-2020 Jumlah
sampai periode lalu 55,000.00
Tuli
Jumlah semua sampai periode ini 58,346,737.92 58,291,737.92 55,000.00 se
Sisa Kas 55,000.00

Kas di Bendahara Penerimaan Rp.55.000,00,-


( Lima Puluh Lima Ribu Rupiah )

terdiri dari :
a. Tunai Rp 55,000.00.-
b. Saldo Bank Rp -
NO. KODE
NO. TGL BUKTI
URAIAN REKENING
REF PENERIMAAN PENGELUARAN SALDO
Mengetahui Jombang, 31-05-2020
Kepala BLUD Bendahara Penerimaan
Puskesmas Jatiwates

drg.AMI SETYANINGRUM
Nip.197509262014122001
Pemerintah Kabupaten Jombang
BLUD PUSKESMAS JATIWATES
Laporan Realisasi Pendapatan dan Anggaran
Bulan Mei Tahun 2020
Jumlah (Rp) Bertambah/(berkurang)

No Uraian Anggaran Realisasi s/d Realisasi Realisasi s/d


dalam DPA Bulan lalu Bulan ini Bulan ini
Rp %

1 2 3 4 5 6=(4+5) 7=(3-5 8=(6/3)x100


PENDAPATAN Err:504 - 3,152,537.92 3,152,537.92 Err:504

Jasa Layanan 229,537.92 - 2,923,000.00 2,923,000.00 (2,693,462.08) 1,273.43

Sewa Kekayaan Daerah - - - -


Kapitasi BPJS - - - -

Non Kapitasi - - - -

Prolanis - - - -

Hibah - - - -

Hasil Kerja Sama - - - -


Pendapatan BLUD yang sah - - - -

Bunga - 229,537.92 229,537.92 (229,537.92)

JUMLAH Err:504 - 3,152,537.92 3,152,537.92 Err:504

Jombang, 31-05-2020
Kepala BLUD Bendahara Penerimaan BLUD
Err:504 Err:504

Err:504 Err:504
Err:504 Err:504
PEMERINTAH KABUPATEN JOMBANG
DINAS KESEHATAN
BLUD PUSKESMAS JATIWATES
Jalan Sultan Agung No. 12 Kec.Jombang
Kabupaten Jombang. Kode Pos 61412
Telp (0321) 853944 Email :pkm.jelakombo1@gmail.com

REGISTER PENUTUPAN KAS

Tanggal Penutupan kas : 31 Mei 2020


Nama Penutup Kas : Err:504
Tanggal Penutupan kas Yang lalu :
Jumlah Transaksi s/d bulan ini
Jumlah penerimaan s/d tanggal 31 Mei 2020 : Rp. 58,346,737.92
Jumlah Pengeluaran s/d tanggal 31 Mei 2020 : Rp. 58,291,737.92
Saldo Buku : Rp. 55,000.00
Saldo Kas : Rp. 55,000.00

Terdiri atas :
1 Uang Kertas :
Pecahan 100000 = 0 lembar : Rp -
Pecahan 50000 = lembar : Rp -
Pecahan 20000 = lembar : Rp -
Pecahan 10000 = lembar : Rp -
Pecahan 5000 = lembar : Rp -
Pecahan 2000 = lembar : Rp -
Pecahan 1000 = lembar : Rp -

2 Uang Logam :
Pecahan 1000 = keping : Rp -
Pecahan 500 = keping : Rp -
Pecahan 200 = keping : Rp -
Pecahan 100 = keping : Rp -
Pecahan 50 = keping : Rp -
Pecahan 25 = keping : Rp -

3 Kertas berharga dan bagian kas yang diizinkan : Rp -


ordonasi/SP2D, Wesel, Cek, Saldo Bank, Materai,
dan sebagainya
4 Jumlah : Rp -
Selisih : Rp -
Penjelasan perbedaan baik positif maupun negatif :
Adanya perbedaan saldo buku dan saldo kas sebesar Rp.0,00,- terdiri
dari silva Tahun Anggaran 2019 yang belum diakui dan belum dicatat
Sebagai Pembiayaan Penerimaan

Mengetahui Bendahara Penerimaan BLUD


Kuasa Pengguna Anggaran Err:504
Err:504

Err:504 Err:504
Err:504 Err:504
PEMERINTAH KABUPATEN JOMBANG
BUKU KAS UMUM
BLUD PUSKESMAS JATIWATES
periode : 01 Mei 2020 s/d 31 Mei 2020

NO. KODE
NO. TGL BUKTI
URAIAN REKENING REF PENERIMAAN PENGELUARAN SALDO
1 Saldo Bulan Lalu - 119,619,897.00
2 01-05-2020 Pembayaran bunga 5.1.2 229,537.92 119,849,434.92
3 04-05-2020 Jasa Layanan 4.1.2.01 325,000.00 120,174,434.92
4 04-05-2020 Honor sukwan bln April a.n Dedik 5.2.1.07.01 200,000.00 119,974,434.92
Catur
5 04-05-2020 Honor sukwan bln April a.n Lina 5.2.1.07.01 200,000.00 119,774,434.92
Wati
6 04-05-2020 Honor Sukawan ln April a.n Delinda 5.2.1.07.01 200,000.00 119,574,434.92
Poppy
7 04-05-2020 Belanja suku cadang computer 5.2.2.26.01 1,500,000.00 118,074,434.92
bulan januari
8 04-05-2020 Belanja servis komputer bln Januari 5.2.2.26.01 1,200,000.00 116,874,434.92
9 04-05-2020 Belanja BBM Pusling bln April 5.2.2.26.01 200,000.00 116,674,434.92
10 04-05-2020 Belanja cetak bln Feb, Maret 5.2.3.27.04 13,060,000.00 103,614,434.92
11 05-05-2020 Belanja CCTV bln April 6,268,183.00 97,346,251.92
12 05-05-2020 Pajak belanja CCTV bln April 731,817.00 96,614,434.92
13 06-05-2020 Jasa Layanan 4.1.2.01 309,000.00 96,923,434.92
14 08-05-2020 Remunerasi insentif pegawai a/n 1,087,938.00 95,835,496.92
Elfrida W
15 08-05-2020 Remunerasi insentif pegawai a/n 749,048.00 95,086,448.92
Cicik Sri W
16 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 941,618.00 94,144,830.92
Sulastri
17 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 1,087,938.00 93,056,892.92
Kamala M
18 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 1,077,120.00 91,979,772.92
Siti Choiriyah
19 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 1,039,034.00 90,940,738.92
Elik Junaidah
20 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 1,062,921.00 89,877,817.92
Nur Choiriyah
21 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 1,428,670.00 88,449,147.92
Tusy Novita
22 08-05-2020 Remuerasi insentif pegawai a/n drg. 5.2.2.26.01 3,025,269.00 85,423,878.92
Amis S
23 08-05-2020 Remunerasi insentif pegawai a/n Tri 5.2.2.26.01 991,924.00 84,431,954.92
W
24 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 912,949.00 83,519,005.92
Rosa Budi
25 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 1,029,346.00 82,489,659.92
Asna Rofiko
26 08-05-2020 Remunerasi insentif pegawai a/n Sri 5.2.2.26.01 977,725.00 81,511,934.92
astutik
27 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 991,924.00 80,520,010.92
Nikmatun K
28 08-05-2020 Remunerasi insentif pegawai a/n Tri 5.2.2.26.01 1,161,775.00 79,358,235.92
istina
29 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 949,326.00 78,408,909.92
Nanik isnaiani
30 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 996,435.00 77,412,474.92
Siti sahidatun
31 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 966,636.00 76,445,838.92
Umi Sholikah
32 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 1,292,951.00 75,152,887.92
Slamet Pujianto
33 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 1,133,918.00 74,018,969.92
Niken K
34 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 935,126.00 73,083,843.92
Siti Windasari
35 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 935,126.00 72,148,717.92
Arif basuki
36 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 912,407.00 71,236,310.92
Riska Aprilia
37 08-05-2020 Remunerai insentif pegawai a/n 5.2.2.26.01 570,135.00 70,666,175.92
Nur kasan
38 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 646,541.00 70,019,634.92
Lina wati
39 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 949,326.00 69,070,308.92
Chusnul chotimah

40 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 963,525.00 68,106,783.92


Siti Pattimah
41 08-05-2020 Remunerasi isentif pegawai a/n 5.2.2.26.01 773,253.00 67,333,530.92
Zully K
42 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 553,096.00 66,780,434.92
Eka retno
43 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 350,000.00 66,430,434.92
Asna Rofiko
44 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 818,400.00 65,612,034.92
drg. Ami S
45 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 525,000.00 65,087,034.92
Sulastri
46 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 541,737.00 64,545,297.92
Delinda P
47 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 949,326.00 63,595,971.92
Nurdiana Dwi K
48 08-05-2020 Remunerasi insentif pegawai a/n 5.2.2.26.01 541,737.00 63,054,234.92
Dedik Catur
49 08-05-2020 Belanja kantong puyer bln Mrt 5.2.2.26.01 2,250,000.00 60,804,234.92

50 12-05-2020 Jasa Layanan 407,000.00 61,211,234.92


51 12-05-2020 Penarikan tunai (kurang bayar rek. 5.2.2.26.01 45,000.00 61,166,234.92
Telepn bln April)
52 12-05-2020 Penarikan tunak (rek listrik, 5.2.2.26.01 1,363,065.00 59,803,169.92
telepon, internet bln Mei)
53 12-05-2020 Jasa Layanan 350,000.00 60,153,169.92
54 14-05-2020 Bayar cek 25 lbr 5.2.2.26.01 50,000.00 60,103,169.92
55 14-05-2020 Bayar tera cek 25 lbr 5.2.2.26.01 75,000.00 60,028,169.92
56 15-05-2020 Terima dana BPJS 102,100.00 60,130,269.92
57 15-05-2020 Terima dana BPJS 55,092,100.00 115,222,369.92
58 20-05-2020 Belanja perlengkapan komputer 5.2.2.26.01 1,950,000.00 113,272,369.92

59 20-05-2020 Jasa Layanan 760,000.00 114,032,369.92


60 23-05-2020 Belanja HT Radiomedik 5.2.3.27.04 4,153,119.00 109,879,250.92
61 23-05-2020 Belanja HT Radiomedik 5.2.3.27.04 5,350,341.00 104,528,909.92
62 23-05-2020 Disetor pajak atas belanja HT 484,881.00 104,044,028.92
Radiomedik
63 23-05-2020 Disetor pajak atas belanja HT 624,659.00 103,419,369.92
Radiomedik
64 23-05-2020 Belanja kantong plastik 5.2.2.26.01 487,500.00 102,931,869.92
65 26-05-2020 Belanja alat kebersihan bln April 5.2.2.26.01 427,800.00 102,504,069.92

66 26-05-2020 Belanja alat listrik bln April 5.2.2.26.01 222,100.00 102,281,969.92


67 26-05-2020 Belanja fotokopi bln April 5.2.2.26.01 150,000.00 102,131,969.92
68 26-05-2020 Belanja ATK bln April 5.2.2.26.01 2,759,000.00 99,372,969.92
69 27-05-2020 Jasa Layanan 321,000.00 99,693,969.92
70 29-05-2020 Belanja perjadin posko covid April- 50,000.00 99,643,969.92
Mei a/n Tri Istina
71 29-05-2020 Belanja perjadin posko covid April- 200,000.00 99,443,969.92
Mei a/n Arif B
72 29-05-2020 Belanja perjadin rapat dinas bln 50,000.00 99,393,969.92
April a/n Siti Syahidatun
73 29-05-2020 Belanja perjadin Covid bln April- 5.2.2.26.01 500,000.00 98,893,969.92
Mei a/n Tri Wahyudi
74 29-05-2020 Belanja perjadin rapat dinas dan 5.2.2.26.01 400,000.00 98,493,969.92
Posko Covid bln April-Mei a/n
Kamala M

75 29-05-2020 Belanja perjadin rapat dinas bln 5.2.2.26.01 100,000.00 98,393,969.92


April-Mei a/n Elfrida W
76 29-05-2020 Belanja perjadin rapat dinas dan 5.2.2.26.01 300,000.00 98,093,969.92
Posko Covid bln April-Mei a/n Zully
K

77 29-05-2020 Belanja perjadin rapat dinas a/n 5.2.2.26.01 100,000.00 97,993,969.92


Sulastri
78 29-05-2020 Belanja perjadin Posko Covid bln 5.2.2.26.01 600,000.00 97,393,969.92
April-Mei a/n elik Junaidah

79 29-05-2020 Belanja perjadin Posko Covid bln 5.2.2.26.01 350,000.00 97,043,969.92


April-Mei a/n Riska A
80 29-05-2020 Belanja perjadin luar daerah a/n 5.2.2.26.01 400,000.00 96,643,969.92
drg. Ami S
81 29-05-2020 Belanja BBm Pusling bln Mei 5.2.2.26.01 300,000.00 96,343,969.92
82 29-05-2020 Belanja perjadin luar daerah a/n dr. 5.2.2.26.01 100,000.00 96,243,969.92
Tusy Novita
83 29-05-2020 Belanja perlengkapan kantor 5.2.2.26.01 3,864,000.00 92,379,969.92
(korden)
84 29-05-2020 Belanja ATK bln Mei 5.2.2.26.01 3,416,600.00 88,963,369.92
85 29-05-2020 Belanja perlengkapan kantor 5.2.2.26.01 202,350.00 88,761,019.92
(papan tulis)
86 29-05-2020 Belanja alat listri bln Mei 5.2.2.26.01 217,200.00 88,543,819.92
87 29-05-2020 Belanja fotokopi bln Mei 5.2.2.26.01 150,000.00 88,393,819.92
88 29-05-2020 Belanja alat pembersih kantor bln 5.2.2.26.01 428,100.00 87,965,719.92
Mei
89 29-05-2020 Terima setoran tunai 396,000.00 88,361,719.92
88,361,719.92
88,361,719.92
88,361,719.92
88,361,719.92
88,361,719.92
88,361,719.92
88,361,719.92
88,361,719.92
88,361,719.92
88,361,719.92
88,361,719.92
88,361,719.92
88,361,719.92
88,361,719.92
88,361,719.92
88,361,719.92
88,361,719.92
88,361,719.92
88,361,719.92
109 88,361,719.92
110 88,361,719.92
111 88,361,719.92
112 88,361,719.92
113 88,361,719.92
114 88,361,719.92
115 88,361,719.92
116 88,361,719.92
117 88,361,719.92
118 88,361,719.92
119 88,361,719.92
120 88,361,719.92
121 88,361,719.92
122 88,361,719.92
123 88,361,719.92
124 88,361,719.92
125 88,361,719.92
126 88,361,719.92
127 88,361,719.92
128 88,361,719.92
129 88,361,719.92
130 88,361,719.92
131 88,361,719.92
132 88,361,719.92
133 88,361,719.92
134 88,361,719.92
135 88,361,719.92
136 88,361,719.92
137 88,361,719.92
138 88,361,719.92
139 88,361,719.92
140 88,361,719.92
141 88,361,719.92
142 88,361,719.92
143 88,361,719.92
144 88,361,719.92
145 88,361,719.92
146 88,361,719.92
147 88,361,719.92
148 88,361,719.92
149 88,361,719.92
150 88,361,719.92
151 88,361,719.92
152 88,361,719.92
153 88,361,719.92
154 88,361,719.92
155 88,361,719.92
156 88,361,719.92
157 88,361,719.92
158 88,361,719.92
159 88,361,719.92
160 88,361,719.92
161 88,361,719.92
162 88,361,719.92
163 88,361,719.92
164 88,361,719.92
165 88,361,719.92
166 88,361,719.92
167 88,361,719.92
168 88,361,719.92
169 88,361,719.92
170 88,361,719.92
171 88,361,719.92
172 88,361,719.92
173 88,361,719.92
174 88,361,719.92
175 88,361,719.92
176 88,361,719.92
177 88,361,719.92
178 88,361,719.92
179 88,361,719.92
180 88,361,719.92
181 88,361,719.92
182 88,361,719.92
183 88,361,719.92
184 88,361,719.92
185 88,361,719.92
186 88,361,719.92
187 88,361,719.92
188 88,361,719.92
189 88,361,719.92
190 88,361,719.92
191 88,361,719.92
192 88,361,719.92
193 88,361,719.92
194 88,361,719.92
195 88,361,719.92
196 88,361,719.92
197 88,361,719.92
198 88,361,719.92
199 88,361,719.92
200 88,361,719.92
201 88,361,719.92
202 88,361,719.92
203 88,361,719.92
204 88,361,719.92
205 88,361,719.92
206 88,361,719.92
207 88,361,719.92
208 88,361,719.92
209 88,361,719.92
210 88,361,719.92
211 88,361,719.92
212 88,361,719.92
213 88,361,719.92
214 88,361,719.92
215 88,361,719.92
216 88,361,719.92
217 88,361,719.92
218 88,361,719.92
219 88,361,719.92
220 88,361,719.92
221 88,361,719.92
222 88,361,719.92
223 88,361,719.92
224 88,361,719.92
225 88,361,719.92
226 88,361,719.92
227 88,361,719.92
228 88,361,719.92
229 88,361,719.92
230 88,361,719.92
231 88,361,719.92
232 88,361,719.92
233 88,361,719.92
234 88,361,719.92
235 88,361,719.92
236 88,361,719.92
237 88,361,719.92
238 88,361,719.92
239 88,361,719.92
240 88,361,719.92
241 88,361,719.92
242 88,361,719.92
243 88,361,719.92
244 88,361,719.92
245 88,361,719.92
246 88,361,719.92
247 88,361,719.92
248 88,361,719.92
249 88,361,719.92
250 88,361,719.92
251 88,361,719.92
252 88,361,719.92
253 88,361,719.92
254 88,361,719.92
255 88,361,719.92
256 88,361,719.92
257 88,361,719.92
258 88,361,719.92
259 88,361,719.92
260 88,361,719.92
261 88,361,719.92
262 88,361,719.92
263 88,361,719.92
264 88,361,719.92
265 88,361,719.92
266 88,361,719.92
267 88,361,719.92
268 88,361,719.92
269 88,361,719.92
270 88,361,719.92
271 88,361,719.92
272 88,361,719.92
273 88,361,719.92
274 88,361,719.92
275 88,361,719.92
276 88,361,719.92
277 88,361,719.92
278 88,361,719.92
279 88,361,719.92
280 88,361,719.92
281 88,361,719.92
282 88,361,719.92
283 88,361,719.92
284 88,361,719.92
285 88,361,719.92
286 88,361,719.92
287 88,361,719.92
288 88,361,719.92
289 88,361,719.92
290 88,361,719.92
291 88,361,719.92
292 88,361,719.92
293 88,361,719.92
294 88,361,719.92
295 88,361,719.92
296 88,361,719.92
297 88,361,719.92
298 88,361,719.92
299 88,361,719.92
300 88,361,719.92
301 88,361,719.92
302 88,361,719.92
303 88,361,719.92
304 88,361,719.92
305 88,361,719.92
306 88,361,719.92
307 88,361,719.92
308 88,361,719.92
309 88,361,719.92
310 88,361,719.92
311 88,361,719.92
312 88,361,719.92
313 88,361,719.92
314 88,361,719.92
315 88,361,719.92
316 88,361,719.92
317 88,361,719.92
318 88,361,719.92
319 88,361,719.92
320 88,361,719.92
321 88,361,719.92
322 88,361,719.92
323 88,361,719.92
324 88,361,719.92
325 88,361,719.92
326 88,361,719.92
327 88,361,719.92
328 88,361,719.92
329 88,361,719.92
330 88,361,719.92
331 88,361,719.92
332 88,361,719.92
333 88,361,719.92
334 88,361,719.92
335 88,361,719.92
336 88,361,719.92
337 88,361,719.92
338 88,361,719.92
339 88,361,719.92
340 88,361,719.92
341 88,361,719.92
342 88,361,719.92
343 88,361,719.92
344 88,361,719.92
345 88,361,719.92
346 88,361,719.92
347 88,361,719.92
348 88,361,719.92
349 88,361,719.92
350 88,361,719.92
351 88,361,719.92
352 88,361,719.92
353 88,361,719.92
354 88,361,719.92
355 88,361,719.92
356 88,361,719.92
357 88,361,719.92
358 88,361,719.92
359 88,361,719.92
360 88,361,719.92
361 88,361,719.92
362 88,361,719.92
363 88,361,719.92
364 88,361,719.92
365 88,361,719.92
366 88,361,719.92
367 88,361,719.92
368 88,361,719.92
369 88,361,719.92
370 88,361,719.92
371 88,361,719.92
372 88,361,719.92
373 88,361,719.92
374 88,361,719.92
375 88,361,719.92
376 88,361,719.92
377 88,361,719.92
378 88,361,719.92
379 88,361,719.92
380 88,361,719.92
381 88,361,719.92
382 88,361,719.92
383 88,361,719.92
384 88,361,719.92
385 88,361,719.92
386 88,361,719.92
387 88,361,719.92
388 88,361,719.92
389 88,361,719.92
390 88,361,719.92
391 88,361,719.92
392 88,361,719.92
393 88,361,719.92
394 88,361,719.92
395 88,361,719.92
396 88,361,719.92
397 88,361,719.92
398 88,361,719.92
399 88,361,719.92
400 88,361,719.92
401 88,361,719.92
402 88,361,719.92
403 88,361,719.92
404 88,361,719.92
405 88,361,719.92
406 88,361,719.92
407 88,361,719.92
408 88,361,719.92
409 88,361,719.92
410 88,361,719.92
411 88,361,719.92
412 88,361,719.92
413 88,361,719.92
414 88,361,719.92
415 88,361,719.92
416 88,361,719.92
417 88,361,719.92
418 88,361,719.92
419 88,361,719.92
420 88,361,719.92
421 88,361,719.92
422 88,361,719.92
423 88,361,719.92
424 88,361,719.92
425 88,361,719.92
426 88,361,719.92
427 88,361,719.92
428 88,361,719.92
429 88,361,719.92
430 88,361,719.92
431 88,361,719.92
432 88,361,719.92
433 88,361,719.92
434 88,361,719.92
435 88,361,719.92
436 88,361,719.92
437 88,361,719.92
438 88,361,719.92
439 88,361,719.92
440 88,361,719.92
441 88,361,719.92
442 88,361,719.92
443 88,361,719.92
444 88,361,719.92
445 88,361,719.92
446 88,361,719.92
447 88,361,719.92
448 88,361,719.92
449 88,361,719.92
450 88,361,719.92
451 88,361,719.92
452 88,361,719.92
453 88,361,719.92
454 88,361,719.92
455 88,361,719.92
456 88,361,719.92
457 88,361,719.92
458 88,361,719.92
459 88,361,719.92
460 88,361,719.92
461 88,361,719.92
462 88,361,719.92
463 88,361,719.92
464 88,361,719.92
465 88,361,719.92
466 88,361,719.92
467 88,361,719.92
468 88,361,719.92
469 88,361,719.92
470 88,361,719.92
471 88,361,719.92
472 88,361,719.92
473 88,361,719.92
474 88,361,719.92
475 88,361,719.92
476 88,361,719.92
477 88,361,719.92
478 88,361,719.92
479 88,361,719.92
480 88,361,719.92
481 88,361,719.92
482 88,361,719.92
483 88,361,719.92
484 88,361,719.92
485 88,361,719.92
486 88,361,719.92
487 88,361,719.92
488 88,361,719.92
489 88,361,719.92
490 88,361,719.92
491 88,361,719.92
492 88,361,719.92
493 88,361,719.92
494 88,361,719.92
495 88,361,719.92
496 88,361,719.92
497 88,361,719.92
498 88,361,719.92
499 88,361,719.92
500 88,361,719.92

Jumlah periode ini 58,291,737.92 89,549,915.00 88,361,719.92


-1 01-01-2020 Jumlah
sampai periode lalu 88,361,719.92
Jumlah semua sampai periode ini 58,291,737.92 89,549,915.00 88,361,719.92
Sisa Kas 88,361,719.92
Tu
s

Kas di Bendahara Penerimaan Rp.88.361.719,92,-


( Delapan Puluh Delapan Juta Tiga Ratus Enam Puluh Satu Ribu Tujuh Ratus Sembilan Belas Rupiah Sembilan
Puluh Dua Sen )
terdiri dari :
a. Tunai Rp 88,361,719.92.-
b. Saldo Bank Rp -

Mengetahui Jombang, 31-05-2020


Kepala BLUD Bendahara Pengeluaran
Puskesmas Jatiwates

drg.AMI SETYANINGRUM Elfrida Wahyurini


Nip.197509262014122001 Nip.197707243003122000
PEMERINTAH KABUPATEN JOMBANG
LAPORAN BELANJA
BLUD PUSKESMAS JATIWATES
periode : 01 Mei 2020 s/d 31 Mei 2020

Kode Anggaran Realisasi s/d Realisasi Realisasi s/d


URAIAN Rekening dalam DPA Bulan lalu Bulan ini Bulan ini
BELANJA OPERASI - 56,739,929.00 56,739,929.00

Belanja Pegawai 5.2.1 600,000.00 600,000.00


Belanja Barang dan Jasa 5.2.2 56,139,929.00 56,139,929.00
Belanja Bunga 5.1.2 - -

Belanja lain-lain 5.1.8 - -

BELANJA MODAL - 67,690,380.00 67,690,380.00

Belanja Tanah 5.2.3 22,563,460.00 22,563,460.00


Belanja Peralatan dan Mesin 5.2.3 22,563,460.00 22,563,460.00
Belanja Gedung dan Bangunan 5.2.3 22,563,460.00 22,563,460.00
Belanja Jalan, Irigasi, dan Jaringan 0 - -
Belanja Aset Tetap Lainnya 0 - -
Belanja Aset Lainnya 0 - -

Mengetahui Jombang, 31-05-2020


Kepala BLUD Bendahara Pengeluaran
Puskesmas Tembelang

dr.PUGUH HARI SUBAGIA, M.Si Rista Khusnia Dewi


Nip.196811102002121005 Nip.199206142015052002
Seksi Dinkes / BLUD PPTK BENDAHARA PENGELUAR
NO
Puskesmas NAMA NIP NAMA
8
9 Puskesmas Bandar Kedungmulyo Ari Istiani 199307172015052001 aku
10 Puskesmas Bareng
11 Puskesmas Bawangan Ploso
12 Puskesmas Blimbing Gudo
13 Puskesmas Blimbing Kesamben
14 Puskesmas Brambang
15 Puskesmas Cukir
16 Puskesmas Dukuhklopo
17 Puskesmas Gambiran 0
18 Puskesmas Jabon
19 Puskesmas Japanan
20 Puskesmas Jarak Kulon
21 Puskesmas Jatiwates Asna Rofiko 198504282011012003 Elfrida Wahyurini
22 Puskesmas Jelakombo Dyah Trinina R.,Amd.Keb. 19790110200312009 Ustati Hanifah,Amd.Kep
23 Puskesmas Jogoloyo
24 Puskesmas Kabuh
25 Puskesmas Keboan
26 Puskesmas Kesamben
27 Puskesmas Kesamben Ngoro
28 Puskesmas Mayangan
29 Puskesmas Megaluh
30 Puskesmas Mojoagung
31 Puskesmas Mojowarno
32 Puskesmas Perak
33 Puskesmas Peterongan
34 Puskesmas Plandaan
35 Puskesmas Plumbon Gambang
36 Puskesmas Pulolor Annisatul Lathifah,Amd.Keb. 198506132010012020
37 Puskesmas Pulorejo
38 Puskesmas Sumobito
39 Puskesmas Tambakrejo
40 Puskesmas Tapen
41 Puskesmas Tembelang Suci Iswati 197011271991022001 Rista Khusnia Dewi
42 Puskesmas Wonosalam
BENDAHARA PENGELUARAN PENGGUNA ANGGARAN
NIP NAMA NIP 21
Kepala BLUD
coba Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 dr.HENDRI MARZUKI 197010312014121001
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 dr.ANDRI SUHARYONO, 196612052001121001
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 drg.ARIES ENANDY 196304121989031019
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 dr.AGUSTINUS SUMARNO196909042002121010
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 MUCHTAR EFFENDY, SKM,197103132000031004
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 drg.NOVIE SOESILOWATI,197512022007012011
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 drg.MUHAMAD ARIF SETI196210151989011002
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 dr.NANIK 196402241989122001
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 drg.ERVIN IKARINI 197608232007012009
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 drg.DYAH SUHARTI 196812132005012011
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 drg.ARIANY RATNANINGT198209192010012009
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 SRI INDAH WAHYUNINGSI196408261986032009
197707243003122000 Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 drg.AMI SETYANINGRUM 197509262014122001
198403032019031010 Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 dr.PUSPITASARI PANTJA 197010192002122004
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 RIZKIE KOERNIAWATI, SK 197103181995012001
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 dr.SRI MUSTIKANING BAT196907142002122003
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 dr.BINTI SUKARTINI 197804212014122001
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 dr.MERIDIAN GEODESI, 197508312006041012
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 dr.DIDIN SUDIANA 196603162002121003
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 dr.DYAH AYU YULYASTUTI197202092010012001
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 dr.FITRIJAH, MM 197211022006042020
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 drg.DIANA ROOSSUMANT197808152014122001
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 dr.AINUN ZUBAIDAH, M.K197707302005012007
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 OISATIN,S.ST, MM 196611051988122002
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 dr.HELENA AGESTINE MA 198508172011012010
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 dr.ASNAN BUDI SASMITO 196910242002121003
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 dr.ADNIYAH SRI NENGSEH197301092014122001
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 PENI DWI SULISTYANI, S 197404242000032002
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 dr.RITA ANDAYANI 197705092011012003
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 dr.HEXAWAN TJAHJA WI 197106082002121006
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 dr.NOER HAJATI, MM 196604112002122005
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 drg.ISTI KENYO ROSANTI 198506052011012002
199206142015052002 Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 dr. PUGUH HARI SUBAGIA,196811102002121005
Dr.drg. SUBANDRIYAH,M.KP 196403161989032000 dr.IVAN UBAIDILLAH HA 198304012011011004
PAGU PENDAPATAN Pejabat Keuangan
NAMA NIP
Kepala BLUD PAGU PENDAPATAN Pejabat Keuangan
Penata 2,648,485,999
Pembina 4,642,094,415
Pembina Utama Muda 1,708,063,525
Pembina Tk. I 2,265,453,200
Pembina Tk. I 763,456,050
Pembina 1,429,200,000
Pembina Utama Muda 4,680,943,642
Pembina Utama Muda 1,214,363,885
Pembina 1,253,845,761
Pembina Tk. I 926,962,407
Penata Tk. I 2,233,350,000
Pembina 842,588,250
Penata 867,100,189 Sulastri 196608271988032006
Pembina Tk. I 1,430,651,609
Pembina 1,745,493,500
Pembina Tk. I 2,811,471,600
Penata 1,650,962,529
Penata 1,781,186,166
Pembina 1,385,103,136
Pembina 2,410,771,000
Pembina 1,725,371,230
Penata 3,674,000,000 coba 123
Pembina 3,341,000,000
Penata Tk. I 2,607,284,924
Penata Tk. I 2,526,964,649
Pembina Tk. I 1,962,198,166
Penata 971,947,897
Penata Tk. I 923,900,000
Penata Tk. I 1,962,584,319
Pembina Tk. I 2,587,933,768
Pembina 855,535,145
Penata Tk. I 2,260,000,000
Pembina Tk. I 1,451,910,535 Eny Winarsih 197302092006042010
Penata Tk. I 2,600,219,095