Bank Jateng Tanggal: Wednesday 30

Jl. Pemuda 142 Semarang Reference 1669816715787

Jawa Tengah
Telp. 024 - 3547541, 3554025

Laporan Mutasi Mutasi:

Kabupaten Cilacap No CIF : 02885553
RSUD CILACAP KAB. CILACAP No Rekening : 3012148703
Periode : 01/11/2022 -

No Tanggal No Ref Keterangan Debet/Kredit Saldo

1 01 Nov 2022 GAC701100453044 ENDANG PEMAKAMAN PASIEN TDK DI (-625,000) 64,450,647

2 01 Nov 2022 GAC701104554581 SUKIRMAN KORAN BANYUMAS EXPRES (-165,000) 64,285,647

3 01 Nov 2022 GAC701122927359 DR,HANANDYANSTO A MNGKTI KULIA (-370,000) 63,915,647

4 01 Nov 2022 GAC701123101366 DR.YULIANA DWI JP MNGKTI KULIA (-370,000) 63,545,647

5 01 Nov 2022 GAC701123325461 SUTIYANTI BERTUGAS SEBAGAI ATL (-400,000) 63,145,647

6 01 Nov 2022 GAC701131025490 RUDY K ATLET HARI KESEHATAN NA (-400,000) 62,745,647

7 01 Nov 2022 GAC701131207518 FIRMAN NR ATLET HARI KESEHATAN (-400,000) 62,345,647

8 01 Nov 2022 GAC701125353637 ENGGAR SK TUGAS ATLET HARI KES (-400,000) 61,945,647

9 01 Nov 2022 GAC701125443774 IRFAN S TUGAS ATLET HARI KES. (-400,000) 61,545,647

10 01 Nov 2022 GAC701125502766 IWANG S TUGAS ATLET HARI KES. (-400,000) 61,145,647

11 01 Nov 2022 GAC701123516168 ADJI PRASETIYO BERTUGAS SEBAGA (-700,000) 60,445,647

12 01 Nov 2022 GAC701123708080 EDI SUSILO BERTUGAS P3K PORSEN (-400,000) 60,045,647

13 01 Nov 2022 GAC701123852215 TRIYONOBERTUGAS P3K PORSENITAS (-400,000) 59,645,647

14 01 Nov 2022 GAC701123926513 PRIMAWAN BERTUGAS P3K PORSENIT (-571,000) 59,074,647

15 01 Nov 2022 GAC70112571305T IDUL PUTRA SPONSHORSIP RSUD CI (-3,500,000) 55,574,647

16 01 Nov 2022 GAC70113030116T MARTIN PP SOSIALISASI PPH 21 (-380,000) 55,194,647

17 01 Nov 2022 GAC70113051197T RAKHMAT H SOSIALISASI PPH 21 (-380,000) 54,814,647

18 01 Nov 2022 695486756785 ATM-DJP: 027065411819097 (-20,000) 54,794,647

19 01 Nov 2022 978646329169 ATM-DJP: 027065412306122 (-20,000) 54,774,647

20 01 Nov 2022 GAC701214418751 BUDIONO KEMENKES (-1,890,000) 52,884,647

21 01 Nov 2022 GAC701214214162 EKO SUPRIATI KEMENKES (-1,290,000) 51,594,647

22 02 Nov 2022 GAC702084124490 CN.577424-PELATIHAN BTCLS AN (-2,200,000) 49,394,647

23 02 Nov 2022 GAC70208412449f CN.577424-PELATIHAN BTCLS AN (-2,900) 49,391,747

24 02 Nov 2022 GAC70210495043T BUDIONO BIAYA HOTEL UTK KEGIAT (-6,600,000) 42,791,747

25 02 Nov 2022 012BO1145170001 SPD 2412/03.01/SPD.GU/X/2022 59,230,744 102,022,491

26 02 Nov 2022 012BO1146390001 SPD 2419/03.01/SPD.GU/XI/2022 30,797,700 132,820,191

27 02 Nov 2022 GAC702123232472 DR.IIP MNGKTI KEG.TTD KERJA SA (-121,500) 132,698,691

User: CHUS2106189, Waktu :30/11/2022 20:58:35 Halaman 1 dari 1

 No Tanggal No Ref Keterangan Debet/Kredit Saldo

28 02 Nov 2022 GAC702123003293 DR.IIP MNGDRI DISKUSI PANEL MA (-50,000) 132,648,691

29 02 Nov 2022 GAC702123318996 DR.JODY M WORKSHOP PENDIDIKAN (-1,112,055) 131,536,636

30 02 Nov 2022 GAC702123410196 SRI BANUNDARI KORD.PENGESAHAN (-370,000) 131,166,636

31 02 Nov 2022 GAC702123543817 AYU KAMILAH KORD.PENGESAHAN KR (-370,000) 130,796,636

32 02 Nov 2022 GAC702123615517 FADLIELAH LATHIEF KORD.PENGESA (-370,000) 130,426,636

33 02 Nov 2022 GAC702123659784 EDI SUSILO PETUGAS P3KPORSENIT (-400,000) 130,026,636

34 02 Nov 2022 GAC702123835164 TROYONO PETUGAS P3KPORSENITAS (-400,000) 129,626,636

35 02 Nov 2022 GAC702123908146 PRIMAWAN PETUGAS P3KPORSENITAS (-1,900,000) 127,726,636

36 02 Nov 2022 GAC702123941495 AJIE P MNGTR PERALATAN TENIS M (-580,000) 127,146,636

37 02 Nov 2022 GAC702124049493 RACHMAT I MNGTR RJK MYLAN DYRA (-1,200,000) 125,946,636

38 02 Nov 2022 GAC702124154360 WISNU AD R MNGTR RJK MYLAN DYR (-360,000) 125,586,636

39 02 Nov 2022 GAC702124232006 RACHMAT I MNGTR JNZ RACHMAT S (-900,000) 124,686,636

40 02 Nov 2022 GAC702124331057 YANUAR A MNGTR JNZ RACHMAT SL (-112,500) 124,574,136

41 03 Nov 2022 GAC703082758778 CN.580914-PEMBAYARAN BPJS KESE (-78,451,065) 46,123,071

42 03 Nov 2022 GAC70308275877f CN.580914-PEMBAYARAN BPJS KESE (-2,900) 46,120,171

43 03 Nov 2022 GAC703131007831 CN.583454-DWITA JAYA PEMBELIAN (-5,000,000) 41,120,171

44 03 Nov 2022 GAC70313100783f CN.583454-DWITA JAYA PEMBELIAN (-2,900) 41,117,271

45 03 Nov 2022 GAC703125653469 RUSWANTO JNZH SAN WIREJA (-174,000) 40,943,271

46 03 Nov 2022 GAC703125735809 SOBARI JNZH SAN WIREJA (-21,750) 40,921,521

47 03 Nov 2022 GAC703125840988 RUSWANTO JNZH TURIMAN (-438,000) 40,483,521

48 03 Nov 2022 GAC703125907588 YANUAR A JNZH TURIMAN (-54,750) 40,428,771

49 03 Nov 2022 GAC703130020976 TEGUH AW JNZH MARSINEM (-174,000) 40,254,771

50 03 Nov 2022 GAC703130101413 TRISNO Y JNZH MARSINEM (-21,750) 40,233,021

51 03 Nov 2022 GAC703130130595 TEGUH AW JNZH TAUFIK H (-120,000) 40,113,021

52 03 Nov 2022 GAC703130159369 TRISNO Y JNZH TAUFIK H (-15,000) 40,098,021

53 03 Nov 2022 GAC703130235057 RUSWANTO JNZH SUMARDI (-174,000) 39,924,021

54 03 Nov 2022 GAC703130303113 ALI S JNZH SUMARDI (-21,750) 39,902,271

55 03 Nov 2022 GAC703130330882 TEGUH AW JNZH KAYZA AZIZA (-174,000) 39,728,271

56 03 Nov 2022 GAC703130415438 DIRSAM JNZH KAYZA AZIZA (-21,750) 39,706,521

57 03 Nov 2022 GAC703130441278 FITRI A WORKSHOP PNGELOLAAN JA (-1,260,000) 38,446,521

58 03 Nov 2022 GAC703130544853 SRI B PNGSESAHAN REKREDENSIAL (-105,000) 38,341,521

59 03 Nov 2022 GAC703130629900 AJIE P MNGNTR DIREKTUR SOSIALI (-630,000) 37,711,521

60 03 Nov 2022 GAC703130718483 AJIE P ANTAR PRLTAN TENIS MEJA (-50,000) 37,661,521
KUSTANTO N PNDTANGANAN MOU
61 03 Nov 2022 GAC703130801956 (-1,192,258) 36,469,263
JAS
62 03 Nov 2022 GAC703132536501 UMI M PULSA DINAS R. MAWAR (-79,200) 36,390,063

User: CHUS2106189, Waktu :30/11/2022 20:58:35 Halaman 2 dari 2

 No Tanggal No Ref Keterangan Debet/Kredit Saldo

63 03 Nov 2022 GAC70313300456T KHAKIMATUSODIQOH RETUR PASIEN (-705,300) 35,684,763

64 03 Nov 2022 GAC70313311672T ANASTASI LS RETUR PASIEN ANAST (-80,000) 35,604,763

65 03 Nov 2022 7404MOBILE a 620,000 36,224,763

66 04 Nov 2022 GAC704092018585 DR. WARTOYO NARSUM REKREDENSIA (-475,000) 35,749,763

67 04 Nov 2022 GAC704092110788 DR. SUKEMI NARSUM REKREDENSIAL (-382,500) 35,367,263

68 04 Nov 2022 GAC704092135459 IMAM W NARSUM REKREDENSIAL BPJ (-332,500) 35,034,763

69 04 Nov 2022 152250711824 ATM-DJP: 027066032149075 (-25,000) 35,009,763

70 04 Nov 2022 291688835986 ATM-DJP: 027066033846091 (-67,500) 34,942,263

71 04 Nov 2022 407122666755 ATM-DJP: 027066034274042 (-17,500) 34,924,763

72 04 Nov 2022 GAC704160750167 AMB RUJUK IBNU SARJITO NY TATY (-360,000) 34,564,763

73 04 Nov 2022 GAC704160545895 AMBULAN RUJUK SARDJITO NY TATI (-1,200,000) 33,364,763

74 05 Nov 2022 GAC705112326852 RETRIBUSI SAMPAH DAN KEBERSIHA (-250,000) 33,114,763

75 05 Nov 2022 GAC705112414818 IDA W KUOTA UNTUK VK IGD (-97,250) 33,017,513

76 05 Nov 2022 GAC705120017847 ELANG T PASIEN TUMIJAN (-366,000) 32,651,513

77 05 Nov 2022 GAC705120056708 WISNU AR PASIEN TUMIJAN (-109,800) 32,541,713

78 05 Nov 2022 GAC705120138831 ELANG T PASIEN BY.NY. SRI YANI (-480,000) 32,061,713

79 05 Nov 2022 GAC705120901876 SITI R PASIEN BY.NY.SRI YANI (-144,000) 31,917,713

80 05 Nov 2022 GAC705121619117 MUSTAKIROH PASIEN BY.NY.SRI YA (-144,000) 31,773,713

81 05 Nov 2022 GAC705121727033 SOLICHUN PASIEN SUKASNO (-366,000) 31,407,713

82 05 Nov 2022 GAC705121806900 TRESNO S PASIEN SUKASNO (-109,800) 31,297,913

83 05 Nov 2022 GAC705121831412 SOLICHUN PASIEN SITI HIDAYATI (-366,000) 30,931,913

84 05 Nov 2022 GAC705121903646 A.MUZAKI PASIEN SITI HIDAYATI (-109,800) 30,822,113

85 05 Nov 2022 GAC705122006320 ELANG T PASIEN KARIN KUSNAEDI (-366,000) 30,456,113

86 05 Nov 2022 GAC705122038535 M. DANIL PASIEN KARIN KUSNAEDI (-109,800) 30,346,313

87 05 Nov 2022 GAC705122117307 ELANG T PASIEN LUSIANA DWI A (-1,200,000) 29,146,313

88 05 Nov 2022 GAC705122154115 M.DANIL PASIEN LUSIANA DWI A (-360,000) 28,786,313

89 05 Nov 2022 GAC705122218985 TEGUH IS PASIEN LUSIANA DWI A (-360,000) 28,426,313

90 05 Nov 2022 GAC705122245634 SOLICHUN PASIEN WAHYU S (-366,000) 28,060,313

91 05 Nov 2022 GAC705122313342 WISNU AR PASIEN WAHYU S (-109,800) 27,950,513

92 05 Nov 2022 GAC705122337249 ELANG T JNZH SETIYA PURWANINGR (-174,000) 27,776,513

93 05 Nov 2022 GAC705122402185 ALI S JNZH SETIYA PURWANINGRUM (-21,750) 27,754,763

94 05 Nov 2022 GAC705122448693 SOLICHUN JNZH TASIKEM (-120,000) 27,634,763

95 05 Nov 2022 GAC705122512769 SOBARI JNZH TASIKEM (-15,000) 27,619,763

96 05 Nov 2022 GAC705122535234 FERIZAL A JNZH BAMBANG AGUNG L (-174,000) 27,445,763

97 05 Nov 2022 GAC705122602406 DIRSAM JNZH BAMBANG AGUNG L (-21,750) 27,424,013

User: CHUS2106189, Waktu :30/11/2022 20:58:35 Halaman 3 dari 3

 No Tanggal No Ref Keterangan Debet/Kredit Saldo

98 05 Nov 2022 GAC705122625552 ELANG T JNZH BY.NY. SULIYAH (-438,000) 26,986,013

99 05 Nov 2022 GAC705122654954 ALI S JNZH BY.NY. SULIYAH (-54,750) 26,931,263

100 05 Nov 2022 GAC705122726712 SOLICHUN JNZH PARIMUN (-462,000) 26,469,263

101 05 Nov 2022 GAC705122954869 SOBARI JNZH PARIMUN (-57,750) 26,411,513

102 05 Nov 2022 GAC705123015776 FERIZAL A JNZH TASAKUR (-120,000) 26,291,513

103 05 Nov 2022 GAC705123037326 DIRSAM JNZH TASAKUR (-15,000) 26,276,513

104 05 Nov 2022 GAC705123054194 TRISNO Y JNZH TASAKUR (-15,000) 26,261,513

105 05 Nov 2022 GAC705123123044 YANUAR A JNZH TASAKUR (-15,000) 26,246,513

106 05 Nov 2022 GAC705123148274 ELANG T JNZH SUTONO (-438,000) 25,808,513

107 05 Nov 2022 GAC705123214528 TRISNO Y JNZH SUTONO (-54,750) 25,753,763

108 07 Nov 2022 GAC70712374011T PROMOSI KEG MRWAT KAMPUNG RSU (-500,000) 25,253,763

109 07 Nov 2022 GAC70712520981T SURAT KABAR SUARA MERDEKA DAN (-1,260,000) 23,993,763

110 07 Nov 2022 GAC707125729485 DIREKTUR RAKERNAS JAKARTA (-1,590,000) 22,403,763

111 07 Nov 2022 GAC707125835741 DR IIP RAKERNAS JAKARTA (-2,970,000) 19,433,763

112 07 Nov 2022 GAC707125929436 ADJI ATLET SURAKARTA (-330,000) 19,103,763

113 07 Nov 2022 GAC707130102908 PRIMAWAN PETUGAS P3K PORSENINI (-479,000) 18,624,763

114 07 Nov 2022 GAC707130549646 BU ISMA PERTEMUAN PENGUATAN AC (-1,310,000) 17,314,763

115 07 Nov 2022 GAC707130752480 ANDRI AMBULAN JENAZAH NAYA ADI (-132,000) 17,182,763

116 07 Nov 2022 GAC707134019153 TRISNO AMBULAN JENAZAH NAYA AD (-16,500) 17,166,263

117 07 Nov 2022 GAC707134207861 ALI AMBULAN JENAZAH NAYA ADIPA (-16,500) 17,149,763

118 07 Nov 2022 GAC707134256268 TEGUH AMBULAN JENAZAH SUKARDI (-429,300) 16,720,463

119 07 Nov 2022 GAC707134354412 DIRSAM AMBULAN JENZAH SUKARDI (-60,750) 16,659,713

120 07 Nov 2022 GAC707134459231 TEGUH AMBUL JENAZAH NGATIYEM K (-153,700) 16,506,013

121 07 Nov 2022 GAC707134603057 DIRSAM AMBUL JENAZAH NGATIYEM (-21,750) 16,484,263

122 07 Nov 2022 GAC707134647635 ANDRI AMBULAN JENAZAH SUNARTO (-120,000) 16,364,263

123 07 Nov 2022 GAC707134752051 ALI AMBULAN JENAZAH SUNARTO KE (-15,000) 16,349,263

124 07 Nov 2022 GAC707134949069 ALI AMBULAN JENAZAH ATI YULIAN (-15,000) 16,334,263

125 07 Nov 2022 GAC707134858568 ANDRI AMBULAN JENAZAH YULIANA (-120,000) 16,214,263
YANUAR AMBULAN JENAZAH NAYA
126 07 Nov 2022 GAC707141157104 (-16,500) 16,197,763
AD
127 07 Nov 2022 012BO1429360001 SPD 2505/03.01/SPD.LS/XI/2022 111,911,466 128,109,229

128 07 Nov 2022 012BO1430110001 SPD 2507/03.01/SPD.GU/XI/2022 78,453,965 206,563,194

129 08 Nov 2022 GAC70812463371T NOVIA MP RETUR PASIEN NOVIA ME (-222,000) 206,341,194

130 08 Nov 2022 GAC708124744980 F.LATHIEF PEMBAYARAN PULSA DIN (-649,000) 205,692,194

131 09 Nov 2022 GAC709125456064 RUSWANTO PASIEN SUDIATI (-366,000) 205,326,194

132 09 Nov 2022 GAC709125539868 WISNU AR PASIEN SUDIATI (-109,800) 205,216,394

User: CHUS2106189, Waktu :30/11/2022 20:58:35 Halaman 4 dari 4

 No Tanggal No Ref Keterangan Debet/Kredit Saldo

133 09 Nov 2022 GAC709125650675 RACHMAT I JNZH MAD SUKEMI (-174,000) 205,042,394

134 09 Nov 2022 GAC709125758177 TRISNO Y JNZH MAD SUKEMI (-21,750) 205,020,644

135 09 Nov 2022 GAC709125818688 RACHMAT I JNZH KASTONO (-1,056,000) 203,964,644

136 09 Nov 2022 GAC709125909216 YANUAR A JNZH KASTONO (-132,000) 203,832,644

137 09 Nov 2022 GAC709130000143 RACHMAT I JNZH MARSUDI (-1,368,000) 202,464,644

138 09 Nov 2022 GAC709130031686 YANUAR A JNZH MARSUDI (-171,000) 202,293,644

139 09 Nov 2022 GAC709130114980 CATUR PY JNZH SUNARTO (-408,100) 201,885,544

140 09 Nov 2022 GAC709131203436 YANUAR A JNZH SUNARTO (-57,750) 201,827,794

141 10 Nov 2022 GAC710133149576 FADLIELAH LATIF TOP UP GOPAY A (-237,000) 201,590,794

142 10 Nov 2022 GAC710133034851 DR.INDARTO S MNGKTI 11TH NASIO (-1,700,000) 199,890,794

143 10 Nov 2022 GAC710132741347 DR.NUGROHO W MNGKTI SIMPOSIUM (-1,900,000) 197,990,794

144 10 Nov 2022 885831147654 ATM-DJP: 027067558710039 (-300,000) 197,690,794

145 10 Nov 2022 097572080935 ATM-DJP: 027067558738157 (-100,000) 197,590,794

146 11 Nov 2022 GAC711085437308 BUDIONO UND. PNYLESAIAN ADM DS (-370,000) 197,220,794

147 11 Nov 2022 GAC711085613656 SUGIARTO UND. PNYLESAIAN ADM D (-570,000) 196,650,794

148 11 Nov 2022 GAC711122753371 DR. SHALATA IIP UND RAKER ARSA (-209,000) 196,441,794

149 11 Nov 2022 GAC711122906536 SOLICHUN PASIEN GINARTI (-366,000) 196,075,794

150 11 Nov 2022 GAC711122937562 M.DANIL M PASIEN GINARTI (-109,800) 195,965,994

151 11 Nov 2022 GAC711123006283 RUSWANTO PASIEN SRI YUDHAWATI (-564,000) 195,401,994

152 11 Nov 2022 GAC711123045718 TRISNO Y PASIEN SRI YUDHAWATI (-70,500) 195,331,494

153 11 Nov 2022 GAC711123108940 SOLICHUN JNZH SANPARTO SAMIN (-462,000) 194,869,494

154 11 Nov 2022 GAC711123144128 SOBARI JNZH SANPARTO SAMIN (-57,750) 194,811,744

155 11 Nov 2022 GAC711123206948 SOLICHUN JNZH UMIYATI (-120,000) 194,691,744

156 11 Nov 2022 GAC711123235492 ALI S JNZH UMIYATI (-15,000) 194,676,744

157 11 Nov 2022 GAC711123326463 FERIZAL A JMPUT JNZH JOKO WALU (-174,000) 194,502,744

158 11 Nov 2022 GAC711123704726 DIRSAM JMPUT JNZH JOKO WALUYO (-21,750) 194,480,994

159 11 Nov 2022 GAC711123802310 FERIZAL A JNZH RUSMINI (-174,000) 194,306,994

160 11 Nov 2022 GAC711123848929 TRISNO Y JNZH RUSMINI (-21,750) 194,285,244

161 11 Nov 2022 GAC711124103206 RUSWANTO ANTAR JNZH JOKO WALUY (-174,000) 194,111,244

162 11 Nov 2022 GAC711124133510 SOBARI ANTAR JNZH JOKO WALUYO (-21,750) 194,089,494

163 14 Nov 2022 GAC714124327017 DIRSAM MNGTR JNZ SANEM (-19,500) 194,069,994

164 14 Nov 2022 GAC714124207325 FERIZAL A MNGTR JNZ SANEM (-156,000) 193,913,994

165 14 Nov 2022 GAC714124133509 DIRSAM MNGTR JNZ KHAMAMI (-57,750) 193,856,244

166 14 Nov 2022 GAC714124029561 TEGUH ADI W MNGTR JNZ KHAMAMI (-462,000) 193,394,244

167 14 Nov 2022 GAC714123957001 DIRSAM MNGTR JNZ DALAIL (-21,750) 193,372,494

User: CHUS2106189, Waktu :30/11/2022 20:58:35 Halaman 5 dari 5

 No Tanggal No Ref Keterangan Debet/Kredit Saldo

168 14 Nov 2022 GAC714123905429 FERIZAL A MNGTR JNZ DALAIL (-174,000) 193,198,494

169 14 Nov 2022 GAC714123829512 TRISNO Y MNGTR JNZ SITI SOBIYA (-15,000) 193,183,494

170 14 Nov 2022 GAC714123748147 TEGUH ADI MNGTR JNZ SITI SOBIY (-106,000) 193,077,494

171 14 Nov 2022 GAC714123614455 SUGIARTO MNGHDRI PENY.ADM LOGI (-250,000) 192,827,494

172 14 Nov 2022 GAC714123514195 ISMAWIYAH MNGKTI PENGUATAN ACA (-1,714,000) 191,113,494

173 14 Nov 2022 GAC714122736003 PEMBYARAN RETURN RUMIYAH (-1,925,000) 189,188,494

174 14 Nov 2022 GAC714122608267 WATINI PULSA DINAS (-32,000) 189,156,494

175 15 Nov 2022 GAC715082820630 ENDANG S PEMAKAMAN PASIEN TDK (-625,000) 188,531,494

176 16 Nov 2022 GAC716133417682 INDERATMI EP RETUR PASIEN DWI (-80,000) 188,451,494

177 16 Nov 2022 GAC716133744032 DWI W KOORDINASI PERIZINAN HD (-240,000) 188,211,494

178 16 Nov 2022 GAC716133826647 DR. YUYUNG B SHARING SESSION F (-370,000) 187,841,494

179 16 Nov 2022 GAC716133922576 ADJI P HARING SESSION FASKES J (-370,000) 187,471,494

180 16 Nov 2022 GAC716133948626 M.ANDRI JNZH SRI ASTUTI (-132,000) 187,339,494

181 16 Nov 2022 GAC716134026738 YANUAR A JNZH SRI ASTUTI (-16,500) 187,322,994

182 16 Nov 2022 GAC716134044886 RACHMAT I PASIEN SUMINAH (-366,000) 186,956,994

183 16 Nov 2022 GAC716134118089 TRESNO S PASIEN SUMINAH (-109,800) 186,847,194

184 16 Nov 2022 GAC716134143026 RACHMAT I JNZH SUTIMAN SURYADI (-174,000) 186,673,194

185 16 Nov 2022 GAC716134221375 DIRSAM JNZH SUTIMAN SURYADI (-21,750) 186,651,444

186 16 Nov 2022 GAC716134245042 RACHMAT I JNZH RODI (-120,000) 186,531,444

187 16 Nov 2022 GAC716134309149 YANUAR A JNZH RODI (-15,000) 186,516,444

188 16 Nov 2022 012BO1458350008 SPD 2606/03.01/SPD.UP/XI/2022 90,000,000 276,516,444

189 17 Nov 2022 GAC71708433104T DR DR SHOFA VIZITASI IZIN PENY (-4,335,000) 272,181,444

190 17 Nov 2022 GAC71708465308T DR REVI O VIZITASI IZIN PENYE (-4,845,000) 267,336,444

191 17 Nov 2022 GAC71708474517T ELI SS AM KEB SKM VIZITASI I (-4,845,000) 262,491,444

192 17 Nov 2022 GAC717085147644 DR RATIH R VISITASI IZIN PENY. (-3,825,000) 258,666,444

193 17 Nov 2022 GAC717085312513 DR. WARTOYO VISITASI IZIN PENY (-760,000) 257,906,444

194 17 Nov 2022 GAC717085340970 DR. SUKEMI VISITASI IZIN PENY. (-510,000) 257,396,444

195 17 Nov 2022 GAC717085400282 IMAM W VISITASI IZIN PENY. PEL (-475,000) 256,921,444

196 17 Nov 2022 371622769821 ATM-DJP: 027068578900142 (-765,000) 256,156,444

197 17 Nov 2022 478953910596 ATM-DJP: 027068584255095 (-255,000) 255,901,444

198 17 Nov 2022 631630671956 ATM-DJP: 027068585039062 (-255,000) 255,646,444

199 17 Nov 2022 770867822652 ATM-DJP: 027068586190002 (-675,000) 254,971,444

200 17 Nov 2022 950062930812 ATM-DJP: 027068587052022 (-40,000) 254,931,444

201 17 Nov 2022 118693786388 ATM-DJP: 027068587721006 (-90,000) 254,841,444

202 17 Nov 2022 306515721196 ATM-DJP: 027068589436153 (-25,000) 254,816,444

User: CHUS2106189, Waktu :30/11/2022 20:58:35 Halaman 6 dari 6

 No Tanggal No Ref Keterangan Debet/Kredit Saldo

203 17 Nov 2022 GAC717101410960 DR. YANNY OSR WORKSHOP THE 4TH (-1,900,000) 252,916,444

204 17 Nov 2022 634893581536 ATM-DJP: 027068577276068 (-100,000) 252,816,444

205 17 Nov 2022 GAC717102124567 DR. FRIANTON TS SIMPOSIUM MUNA (-1,700,000) 251,116,444

206 17 Nov 2022 GAC717102319317 DR. AGUNG S PERT. ILMIAH PERDO (-1,700,000) 249,416,444

207 17 Nov 2022 588439922315 ATM-DJP: 027068580899102 (-300,000) 249,116,444

208 17 Nov 2022 725568011254 ATM-DJP: 027068577324099 (-300,000) 248,816,444

209 17 Nov 2022 GAC71711122994T DEWI A RETUR PASIEN TURISEM (-1,927,404) 246,889,040

210 18 Nov 2022 GAC718111054555 DWI W KOORDINASI PENCAIRAN JP (-200,000) 246,689,040

211 18 Nov 2022 GAC718111135536 DR. RAMA AO SARASEHAN KOORDINA (-580,000) 246,109,040

212 18 Nov 2022 GAC718111242199 DR. ANDY A SARASEHAN KOORDINAT (-995,000) 245,114,040

213 18 Nov 2022 GAC718111316321 DR. HANANDYASTO AP SARASEHAN K (-505,000) 244,609,040

214 18 Nov 2022 GAC718111358629 DR RISKI W SARASEHAN KOORDINAT (-420,000) 244,189,040

215 18 Nov 2022 GAC718111426107 ADJI P SHARING SESSION KEPATUH (-190,000) 243,999,040

216 18 Nov 2022 GAC718111519567 SALIYAN PINJAM OBAT AMINOPHYLL (-490,000) 243,509,040

217 18 Nov 2022 GAC718111654140 BAYU SM PINJAM OBAT AMINOPHYLL (-370,000) 243,139,040

218 18 Nov 2022 GAC718111725888 CATUR PY PASIEN PUPUT E (-366,000) 242,773,040

219 18 Nov 2022 GAC718111827006 WISNU AR PASIEN PUPUT E (-109,800) 242,663,240

220 19 Nov 2022 GAC719094032088 DR. KELLY K SARASEHAN KOOR PEN (-590,000) 242,073,240

221 19 Nov 2022 GAC719094125592 SARDIONO MNDMPINGI BUPATI PROS (-340,000) 241,733,240

222 19 Nov 2022 GAC719094241505 ADJI P MNDMPINGI BUPATI PROSES (-340,000) 241,393,240

223 19 Nov 2022 GAC719094316370 RUSWANTO PASIEN KARWIYEM (-366,000) 241,027,240

224 19 Nov 2022 GAC719094346374 WISNU AR PASIEN KARWIYEM (-109,800) 240,917,440

225 19 Nov 2022 GAC719094414809 RUSWANTO PASIEN DWI S BY NY (-300,000) 240,617,440

226 19 Nov 2022 GAC719094507345 ISTI RK PASIEN DWI S BY NY (-90,000) 240,527,440

227 19 Nov 2022 GAC719094532591 SITI R PASIEN DWI S BY NY (-90,000) 240,437,440

228 19 Nov 2022 GAC719094604668 ELANG T PASIEN ZASKIA FN (-366,000) 240,071,440

229 19 Nov 2022 GAC719094701425 WISNU AR PASIEN ZASKIA FN (-109,800) 239,961,640

230 19 Nov 2022 GAC719094751247 ELANG T JNZH NGADINO (-120,000) 239,841,640

231 19 Nov 2022 GAC719094834898 ALI S JNZH NGADINO ARJAR S (-15,000) 239,826,640

232 19 Nov 2022 GAC719095039231 SOLICHUN PASIEN HARDJONO H (-366,000) 239,460,640

233 19 Nov 2022 GAC719095136657 M.DANIL PASIEN HARDJONO H (-109,800) 239,350,840

234 19 Nov 2022 GAC719095208763 SOLICHUN JNZH MASIJAN (-462,000) 238,888,840

235 19 Nov 2022 GAC719095241779 SOBARI JNZH MASIJAN (-57,750) 238,831,090

236 21 Nov 2022 0225575524-8472 TRF BIFAST INCOMING 473,450 239,304,540

237 21 Nov 2022 GAC721125022612 DIR MNGDRI SUMPAH JABATAN PJ (-370,000) 238,934,540

User: CHUS2106189, Waktu :30/11/2022 20:58:35 Halaman 7 dari 7

 No Tanggal No Ref Keterangan Debet/Kredit Saldo

238 21 Nov 2022 GAC721124926031 DWI WIDODO MNGTR DIR SUMPAH PJ (-1,085,000) 237,849,540

239 21 Nov 2022 GAC721124632683 YANUAR ABIDIN MNGTR JNZH MARFU (-21,750) 237,827,790

240 21 Nov 2022 GAC721124555402 FERIZAL A MNGTR JNZH MARFUAH (-153,700) 237,674,090

241 21 Nov 2022 GAC721124517342 DIRSAM MNGTR JNZH SALIYAH (-54,750) 237,619,340

242 21 Nov 2022 GAC721124404230 FERIZAL A MNGTR JNZH SALIYAH (-438,000) 237,181,340

243 21 Nov 2022 GAC721124330568 M.DANIL MUJIB MNGTR RJK AN.MUS (-109,800) 237,071,540

244 21 Nov 2022 GAC721124235807 FERIZAL A MNGTR RJK AN.MUSLIH (-366,000) 236,705,540

245 21 Nov 2022 GAC721124049444 DR.KELLY KUSWIDIYANTO MENDPING (-150,000) 236,555,540

246 21 Nov 2022 GAC721123936195 DWI WIDODO MNGTR DIR ACARA RAM (-340,000) 236,215,540

247 21 Nov 2022 GAC721123821971 SUGIANTO MNGKTI UJIAN KOMPETEN (-1,110,000) 235,105,540

248 21 Nov 2022 GAC721123552477 DR.ANGGI AP MNGKTI UJI KOMPETE (-1,110,000) 233,995,540

249 21 Nov 2022 GAC721123009237 IIN WAHYUNI PULSA DINAS KEUANG (-200,000) 233,795,540
MUTNGIMATURROKHMAH PULSA
250 21 Nov 2022 GAC721122819508 (-104,000) 233,691,540
DINAS
251 22 Nov 2022 GAC722090039853 CN.643070-PEMBAYARAN BPJS KESE (-205,679,833) 28,011,707

252 22 Nov 2022 GAC72209003985f CN.643070-PEMBAYARAN BPJS KESE (-2,900) 28,008,807

253 22 Nov 2022 GAC72210330529T JOURNAL MEDIA PEMBAYARAN TABLO (-350,000) 27,658,807

254 23 Nov 2022 GAC723102451673 DR. MAHASTINI KONGRES NASIONAL (-1,700,000) 25,958,807

255 23 Nov 2022 030259215531 ATM-DJP: 027069618338144 (-300,000) 25,658,807

256 23 Nov 2022 GAC723103344958 ENDANG S BBM AMBULAN OPERASION (-1,000,000) 24,658,807

257 23 Nov 2022 GAC723110307598 RACHMAT I PASIEN SATIEM (-366,000) 24,292,807

258 23 Nov 2022 GAC723110344782 IBNU BS PASIEN SATIEM (-109,800) 24,183,007

259 23 Nov 2022 GAC723110434317 SOLICHUN PASIEN PARWOTO (-366,000) 23,817,007

260 23 Nov 2022 GAC723110503541 TRESNO S PASIEN PARWOTO (-109,800) 23,707,207

261 23 Nov 2022 GAC723110529865 TEGUH AW JNZH MARYATI (-174,000) 23,533,207

262 23 Nov 2022 GAC723110611215 DIRSAM JNZH MARYATI (-21,750) 23,511,457

263 23 Nov 2022 GAC723110649109 ENDANG S JNZH MARYATI (-21,750) 23,489,707

264 23 Nov 2022 GAC723110712337 TEGUH AW JNZH SALAMAH (-120,000) 23,369,707

265 23 Nov 2022 GAC723110742984 SOBARI JNZH SALAMAH (-15,000) 23,354,707

266 23 Nov 2022 GAC723110803130 DIRSAM JNZH SALAMAH (-15,000) 23,339,707

267 23 Nov 2022 GAC723110831075 RACHMAT I JNZH NGADIMIN (-156,000) 23,183,707

268 23 Nov 2022 GAC723110854969 YANUAR A JNZH NGADIMIN (-19,500) 23,164,207

269 23 Nov 2022 GAC723111059846 RACHMAT I JNZH SALMAN SUHAMDI (-156,000) 23,008,207

270 23 Nov 2022 GAC723111142847 TRISNO Y JNZH SALMAN SUHAMDI (-19,500) 22,988,707

271 23 Nov 2022 GAC723111212560 M.ANDRI JNZH DASIKEM (-156,000) 22,832,707

272 23 Nov 2022 GAC723111243524 ALI S JNZH DASIKEM (-19,500) 22,813,207

User: CHUS2106189, Waktu :30/11/2022 20:58:35 Halaman 8 dari 8

 No Tanggal No Ref Keterangan Debet/Kredit Saldo

273 23 Nov 2022 GAC723111311666 TRISNO Y JNZH DASIKEM (-19,500) 22,793,707

274 23 Nov 2022 GAC723111335646 FERIZAL A JNZH SLAMET RIYADI (-120,000) 22,673,707

275 23 Nov 2022 GAC723111401217 DIRSAM JNZH SLAMET RIYADI (-15,000) 22,658,707

276 23 Nov 2022 GAC723111422509 FERIZAL A JNZH LASEM (-156,000) 22,502,707

277 23 Nov 2022 GAC723111450255 DIRSAM JNZH LASEM (-19,500) 22,483,207

278 23 Nov 2022 GAC723111514025 SOLICHUN JNZH NARTI (-438,000) 22,045,207

279 23 Nov 2022 GAC723111540090 SOBARI JNZH NARTI (-54,750) 21,990,457

280 23 Nov 2022 GAC723111601306 RACHMAT I JNZH FEBRIAN P (-210,000) 21,780,457

281 23 Nov 2022 GAC723111642313 YANUAR A JNZH FEBRIAN P (-26,250) 21,754,207

282 23 Nov 2022 GAC723111706591 DR MOCH ICHLAS KEG. PENYA. BAN (-1,590,000) 20,164,207

283 23 Nov 2022 GAC723111751893 DR SHALATA IIP KEG. PENYA. BAN (-6,235,562) 13,928,645

284 23 Nov 2022 GAC723111821059 TAUFIK A KEG. PENYA. BANPER (-1,590,000) 12,338,645

285 23 Nov 2022 GAC723111848045 SRI B PNGESAHAN REKREDENSIAL D (-370,000) 11,968,645

286 23 Nov 2022 GAC723111937859 AYU K PNGESAHAN REKREDENSIAL D (-370,000) 11,598,645

287 23 Nov 2022 GAC723112001559 F LATHIEF PNGESAHAN REKREDENSI (-370,000) 11,228,645

288 23 Nov 2022 GAC723112030245 CATUR PY JNZH SALAMAH (-120,000) 11,108,645

289 23 Nov 2022 GAC723112102116 YANUAR A JNZH SALAMAH (-15,000) 11,093,645

290 23 Nov 2022 GAC723112558652 SITI H WORKSHOP DAN RAKER HOSP (-820,000) 10,273,645

291 23 Nov 2022 GAC723113053380 ARUM Y WORKSHOP DAN RAKERNAS (-520,000) 9,753,645

292 23 Nov 2022 GAC723113201249 DR SHALATA IIP KEG PENY.BANPER (-6,000,000) 3,753,645

293 23 Nov 2022 GAC723113255369 SITI H WORKSHOP & RAKERNAS HOS (-600,000) 3,153,645

294 24 Nov 2022 GAC724130417292 HASANUDDIN KEG BAKSOS HUT KORP (-65,000) 3,088,645

295 24 Nov 2022 GAC724130602042 SLAMET P KEG BAKSOS HUT KORPRI (-65,000) 3,023,645

296 24 Nov 2022 GAC724130635604 ADJI P KEG BAKSOS HUT KORPRI & (-165,000) 2,858,645

297 24 Nov 2022 GAC724130742598 ADJI P ANTAR DIR. PENYALURAN B (-140,000) 2,718,645

298 24 Nov 2022 GAC724130854253 CATUR P JNZH TUKIMAN (-386,900) 2,331,745

299 24 Nov 2022 GAC724130957251 ALI S JNZH TUKIMAN (-54,750) 2,276,995

300 24 Nov 2022 GAC724132504729 PENGEMBALIAN PS SALAH TRNSFER (-473,450) 1,803,545

301 25 Nov 2022 GAC725125227618 SRI B KOOR. PNGESAHAN REKREDNS (-128,000) 1,675,545

302 25 Nov 2022 GAC725125412836 SOLICHUN PASIEN ANGGIT DWI S (-366,000) 1,309,545

303 25 Nov 2022 GAC725125541804 TRESNO S PASIEN ANGGIT DWI S (-109,800) 1,199,745

304 26 Nov 2022 GAC726103806444 UMI M PULSA RUANG MAWAR (-110,000) 1,089,745

305 28 Nov 2022 012BO1301350001 SPD 2711/03.01/SPD.GU/XI/2022 205,682,733 206,772,478

306 28 Nov 2022 GAC728135054350 CN.668521-DR MOCH IKHLAS HOTEL (-480,000) 206,292,478

307 28 Nov 2022 GAC72813505435f CN.668521-DR MOCH IKHLAS HOTEL (-2,900) 206,289,578

User: CHUS2106189, Waktu :30/11/2022 20:58:35 Halaman 9 dari 9

 No Tanggal No Ref Keterangan Debet/Kredit Saldo

308 28 Nov 2022 GAC728142014134 PK SUGIANTO BIMTEK BARANG JASA (-100,000) 206,189,578

309 28 Nov 2022 GAC728141910618 DR ANGGI PELATIHAN BARANG JASA (-100,000) 206,089,578

310 28 Nov 2022 GAC728141737615 B EKO S PELATIHAN BARANG JASA (-1,238,000) 204,851,578

311 28 Nov 2022 GAC728141639337 SETYA P PELATIHAN IRR (-430,000) 204,421,578

312 28 Nov 2022 GAC728141536959 TEGUH WALUYO PELATIHAN IRR (-2,630,000) 201,791,578

313 28 Nov 2022 GAC728141401947 TUPAR PELATIHAN IRR (-430,000) 201,361,578

314 28 Nov 2022 GAC728141317204 DR RETNO PELATIHAN IRR (-430,000) 200,931,578

315 28 Nov 2022 GAC728141229612 DR HASTO PELATIHAN IRR (-430,000) 200,501,578

316 28 Nov 2022 GAC728141108622 HASDI BIMTEK APLIKASI GAJI (-75,000) 200,426,578

317 28 Nov 2022 GAC728140930949 UNGGUL UJI BIMTEK SIM GAJI PT (-71,250) 200,355,328

318 28 Nov 2022 GAC728140654940 AJIE P MENGANTAR DIR SOLO (-1,640,000) 198,715,328

319 28 Nov 2022 708806820352 ATM-DJP: 027070521866159 (-3,750) 198,711,578

320 28 Nov 2022 GAC728160439159 RUSWANTO PASIEN SUGIYANTO (-366,000) 198,345,578

321 28 Nov 2022 GAC728160623227 TRESNO S PASIEN SUGIYANTO (-109,800) 198,235,778

322 28 Nov 2022 GAC728160647671 SOLICHUN PASIEN WINDHU P (-300,000) 197,935,778

323 28 Nov 2022 GAC728160719837 IBNU BS PASIEN WINDHU P (-90,000) 197,845,778

324 28 Nov 2022 GAC728160738439 RUSWANTO JNZH BY. NY RYAN (-462,000) 197,383,778

325 28 Nov 2022 GAC728160820104 TRISNO Y JNZH BY. NY RYAN (-57,750) 197,326,028

326 28 Nov 2022 GAC728160841010 FERIZAL A JNZH SALIYEM (-174,000) 197,152,028

327 28 Nov 2022 GAC728160903054 TRISNO Y JNZH SALIYEM (-21,750) 197,130,278

328 28 Nov 2022 GAC728160927350 RUSWANTO JNZH KEMANYA (-300,000) 196,830,278

329 28 Nov 2022 GAC728160952400 SOBARI JNZH KEMANYA S (-37,500) 196,792,778

330 28 Nov 2022 GAC728161021305 TEGUH AW JNZH PURNOMO BIN RUST (-1,494,000) 195,298,778

331 28 Nov 2022 GAC728161051716 DIRSAM JNZH PURNOMO BIN RUSTAM (-186,750) 195,112,028

332 28 Nov 2022 GAC728161115969 CATUR PY JNZH MISS X (-366,000) 194,746,028

333 28 Nov 2022 GAC728161147562 TRISNO Y JNZH MISS X (-45,750) 194,700,278

334 28 Nov 2022 GAC728161236304 M.ANDRI JNZH ARFIAH BY NY (-174,000) 194,526,278

335 28 Nov 2022 GAC728161315595 YANUAR A JNZH ARFIAH BY NY (-21,750) 194,504,528

336 28 Nov 2022 GAC728161338033 TEGUH AW JNZH DIAN PS (-174,000) 194,330,528

337 28 Nov 2022 GAC728161452132 DIRSAM JNZH DIAN PS (-21,750) 194,308,778

338 29 Nov 2022 GAC72909095067T RETUR PASIEN SUSWATININGSIH (-2,080,100) 192,228,678

339 29 Nov 2022 000976561922 KOREKSI 480,000 192,708,678

340 30 Nov 2022 3012148703INC PEMBAYARAN BUNGA JAGIR/TAB. 11,220 192,719,898

341 30 Nov 2022 3012148703INC JAGIR/BEND PENGEL PEMBANTU RSU (-11,220) 192,708,678

342 30 Nov 2022 GAC73008292546f CN.676198-CV BAG KIRIM DOKUMEN (-2,900) 192,705,778

User: CHUS2106189, Waktu :30/11/2022 20:58:35 Halaman 10 dari 10

 No Tanggal No Ref Keterangan Debet/Kredit Saldo

343 30 Nov 2022 GAC730082925463 CN.676198-CV BAG KIRIM DOKUMEN (-40,000) 192,665,778

344 30 Nov 2022 GAC730081115581 MANUNGKI FP PNGUATAN PERIZINAN (-370,000) 192,295,778

345 30 Nov 2022 GAC730081229573 SITI H WORKSHOP & RAKERNAS SAN (-230,000) 192,065,778

346 30 Nov 2022 GAC730081717080 ARUM Y WORKSHOP & RAKERNAS SAN (-80,000) 191,985,778

347 30 Nov 2022 GAC730081826488 DR ANGGI AP GRAND LAUNCHING KL (-270,000) 191,715,778

348 30 Nov 2022 GAC730081907930 A. HADIYANTO LOKAKARYA KURIKUL (-370,000) 191,345,778

349 30 Nov 2022 GAC730081944448 FAHMI AFE MNGNTAR KABAG KEU LO (-370,000) 190,975,778

350 30 Nov 2022 GAC730082058386 SOLICHUN JNZH ISNA JUNIATI (-156,000) 190,819,778

351 30 Nov 2022 GAC730082535735 ALI S JNZH ISNA JUNIATI (-19,500) 190,800,278

352 30 Nov 2022 GAC730082600766 DR SHALATA IIP KEG. PENYALURAN (-105,500) 190,694,778

353 30 Nov 2022 006543687485 TRF REK VIA ATM (ISSUER) (C) 1,800,000 192,494,778

354 30 Nov 2022 GAC730145537171 DANI P PULSA DINAS (-50,000) 192,444,778

355 30 Nov 2022 GAC730145623815 DR JONY S SIMPOSIUM KONAS-XIII (-1,900,000) 190,544,778

356 30 Nov 2022 966158651117 ATM-DJP: 027071055550019 (-100,000) 190,444,778

357 30 Nov 2022 GAC730145824042 DR DWI I HYBRID SIMPOSIUM (-1,900,000) 188,544,778

358 30 Nov 2022 314397485985 ATM-DJP: 027071064104044 (-100,000) 188,444,778

359 30 Nov 2022 GAC730150128363 DR LIA A SIMPOSIUM MALANG INTE (-1,900,000) 186,544,778

360 30 Nov 2022 555525842438 ATM-DJP: 027071055471104 (-100,000) 186,444,778

DR HANANNDYASTO SIMPOSIM DAN
361 30 Nov 2022 GAC730150244430 (-1,900,000) 184,544,778
W
362 30 Nov 2022 841700624240 ATM-DJP: 027071055372015 (-100,000) 184,444,778

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