DAFTAR PEMBAYARAN TAMBAHAN PENGHASILAN

UPT PUSKESMAS WILAYAH KERJA LIMA KAUM I

Berdasarkan Peraturan Bupati Nomor 8 Tahun 2014 Tanggal 28 Maret 2014
BULAN JANUARI 2016

NO

NAMA / NIP

1
1

2
Dr.Hj.Susi Julianti

GOL

JABATAN

IV/a

19710719 200312 2 001

2

Isharianto, SKM

III/b

19750909 199503 1 001

3

Drg.Merry Viani

III/d

19800513 200801 2 006

4

Dr.Sri Indrayani

III/c

19800501 200803 2 001

5

Andice

III/d

19660814 198803 2 009

6

Yusmanidar,Amd.Gz

III/d

19650330 198702 2 001

7

Irawati

III/d

19680410 198903 2 005

8

Henny Dwi Praptiwi

III/d

19690727 198912 2 001

9

Zulmahona

III/d

19710312 199101 2 001

10

Efi Darmaiza

III/d

19690527 198911 2 002

11

Fitri Yenny Ambia

III/d

19691210 199003 2 012

12

Endri Yanti

III/c

19691025 199101 2 001

Yasniati

III/c

13
19720516 199303 2 006
14

Nofriyenti

III/c

19740408 199503 2 001

15

Harri Saputra,S.Farm.Apt

III/c

19850406 201001 1 029

16

Siska Yenti,Amd.Far

III/b

19820929 200501 2 006

17

Wita Mardiyanti Amd.Kep

III/b

19801025 200501 2 006

18

Yulia Wati,Amd.KL
19790717 200604 2 020

III/b

Ka.UPT Puskesmas
Kasubag TU
Dokter Gigi
Dokter Umum
Perawat Pustu Bukit
Gombak
PNS Fungsional
PNS Fungsional
Bidan Pustu Baringin
PNS Fungsional
Bendahara
Pengeluaran
Pembantu
PNS Fungsional
PNS Fungsional
Bendahara
Penerimaan
Pembantu
PNS Fungsional
Penyimpan barang
PNS Fungsional
PNS Fungsional
PNS Fungsional

TAMBAHAN
PENGHASILAN
5

PENGURANGAN
JAM KERJA
TK /
PAGI SIANG SORE SAKIT
9

JUMLAH
PENGURANGAN
%
Rp.
10

PPh
Pasal 21

DITERIMA

11(9x5)

12(5-10)

DITERIMA
BERSIH

TANDA TANGAN

14(11-12)

15

Rp

750,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

750,000

Rp

13
112,500

Rp

637,500

Rp

565,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

565,000

Rp

28,250

Rp

536,750 2

Rp

500,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

500,000

Rp

25,000

Rp

475,000

Rp

500,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

500,000

Rp

25,000

Rp

475,000 4

,
Rp

300,000

1.5%

0.0%

0.0%

0.0%

1.5% Rp

4,500

Rp

295,500

Rp

14,775

Rp

280,725

Rp

250,000

4.5%

0.0%

0.0%

0.0%

4.5% Rp

11,250

Rp

238,750

Rp

11,938

Rp

226,812 6

Rp

250,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

250,000

Rp

12,500

Rp

237,500

Rp

300,000

1.5%

0.0%

0.0%

0.0%

1.5% Rp

4,500

Rp

295,500

Rp

14,775

Rp

280,725 8

Rp

250,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

250,000

Rp

12,500

Rp

237,500

Rp

560,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

560,000

Rp

28,000

Rp

532,000 10

Rp

250,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

250,000

Rp

12,500

Rp

237,500

Rp

250,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

250,000

Rp

12,500

Rp

237,500 12

Rp

560,000

1.5% Rp

8,400

Rp

551,600

Rp

27,580

Rp

524,020

Rp

250,000

4.5%

0.0%

0.0%

0.0%

4.5% Rp

11,250

Rp

238,750

Rp

11,938

Rp

226,812 14

Rp

540,000

3.0%

0.0%

0.0%

0.0%

3.0%

Rp

16,200

Rp

523,800

Rp

26,190

Rp

497,610

Rp

250,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

250,000

Rp

12,500

Rp

237,500 16

Rp

250,000

1.5%

0.0%

0.0%

0.0%

1.5% Rp

3,750

Rp

246,250

Rp

12,313

Rp

233,937

Rp

250,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

250,000

Rp

12,500

Rp

237,500 18

1.5%

0.0%

0.0%

0.0%

11

13

15

17

NO
19

NAMA / NIP

GOL

Lucy Hammany,AMK

III/a

19790201 200604 2 018

20

Syri Sandra Fuspaliza,AMK

III/a

19810116 200604 2 012

21

Rika,AMK

III/a

19800929 200701 2 003

22

Sari Febrianita,AMKG

II/c

19870218 200901 2 004

23

Sri Zekiarti

IIIa

19800123 200212 2 005

24

Devi Olivia

III/a

19771006 200701 2 004

25

Mia Oktaviana

II/c

19771006 200701 2 004

26

Veni Z.

II/c

19781007 200701 2 004

27

Syafrizal

II/b

19731017 200701 1 002

28

Marnis

II/a

19781123 200701 2 003

29

Zulharbi
19720412 200701 1 009
J U M LAH

II/a

JABATAN
PNS Fungsional
PNS Fungsional
PNS Fungsional
PNS Fungsional
PNS Fungsional
PNS Fungsional
PNS Fungsional
PNS Fungsional
Staf Puskesmas
Staf Puskesmas
Staf Puskesmas

TAMBAHAN
PENGHASILAN

PENGURANGAN
JAM KERJA
TK /
PAGI SIANG SORE SAKIT

JUMLAH
PENGURANGAN
%
Rp.

DITERIMA
BERSIH

PPh
Pasal 21

DITERIMA

Rp

250,000

1.5%

0.0%

0.0%

0.0%

1.5% Rp

3,750

Rp

246,250

Rp

12,313

Rp

233,937 19

Rp

250,000

3.0%

0.0%

0.0%

0.0%

3.0% Rp

7,500

Rp

242,500

Rp

12,125

Rp

230,375

Rp

250,000

3.0%

0.0%

0.0%

0.0%

3.0% Rp

7,500

Rp

242,500

Rp

12,125

Rp

230,375 21

Rp

220,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

220,000

Rp

Rp

220,000

Rp

250,000

1.5%

0.0%

0.0%

0.0%

1.5% Rp

3,750

Rp

246,250

Rp

12,313

Rp

233,937 23

Rp

250,000

1.5%

0.0%

0.0%

0.0%

1.5% Rp

3,750

Rp

246,250

Rp

12,313

Rp

233,937

Rp

220,000

1.5%

0.0%

0.0%

0.0%

1.5% Rp

3,300

Rp

216,700

Rp

Rp

216,700 25

Rp

220,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

220,000

Rp

Rp

220,000

Rp

335,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

335,000

Rp

Rp

335,000 27

Rp

335,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

335,000

Rp

Rp

335,000

Rp

335,000

3.0%

0.0%

0.0%

0.0%

3.0%

Rp

10,050

Rp

324,950

Rp

Rp

324,950 29

Rp

9,740,000

Rp

99,450

Rp

9,640,550

Rp

474.448

Rp

TANDA TANGAN

20

22

24

26

28

9,166,102

Terbilang : Sembilan Juta Enam Ratus Empat Puluh Ribu Lima Ratus Lima Puluh Rupiah

Kepala Dinas Kesehatan

Selaku Pengguna Anggaran

Pejabat Penatausahaan Keuangan

Bendahara Pengeluaran

Lima Kaum, 30 Januari 2016

Ka.UPT Puskesmas Wil.Kerja Lima Kaum I

Dr.Hj.Dasmiwarita M.Kes
NIP. 19600915 198903 2 003

Fitriani,SE,M.Kes
NIP. 19630507 198303 2 001

Herawati,SE
NIP. 19780903 200212 2 002

dr.Hj Susi Julianti

NIP. 19710719 200312 2 001

NO

NAMA / NIP

GOL

JABATAN

TAMBAHAN
PENGHASILAN

PENGURANGAN
JAM KERJA
TK /
PAGI SIANG SORE SAKIT

JUMLAH
PENGURANGAN
%
Rp.

DITERIMA

PPh
Pasal 21

DITERIMA
BERSIH

TANDA TANGAN

DAFTAR PEMBAYARAN TAMBAHAN PENGHASILAN

UPT PUSKESMAS WILAYAH KERJA LIMA KAUM I
Berdasarkan Peraturan Bupati Nomor 8 Tahun 2014 Tanggal 28 Maret 2014
BULAN APRIL 2016

NO

NAMA / NIP

1
1

2
Dr.Hj.Susi Julianti

GOL

JABATAN

IV/a

19710719 200312 2 001

2

Isharianto, SKM

III/b

19750909 199503 1 001

3

Drg.Merry Viani

III/d

19800513 200801 2 006

4

Dr.Sri Indrayani

III/c

19800501 200803 2 001

5

Andice

III/d

19660814 198803 2 009

6

Yusmanidar,Amd.Gz

III/d

19650330 198702 2 001

7

Irawati

III/d

19680410 198903 2 005

8

Henny Dwi Praptiwi

III/d

19690727 198912 2 001

9

Zulmahona

III/d

19710312 199101 2 001

10

Efi Darmaiza

III/d

19690527 198911 2 002

11

Fitri Yenny Ambia

III/d

19691210 199003 2 012

12

Endri Yanti

III/c

19691025 199101 2 001

Yasniati

III/c

13
19720516 199303 2 006
14

Nofriyenti

III/c

19740408 199503 2 001

15

Harri Saputra,S.Farm.Apt

III/c

19850406 201001 1 029

16

Siska Yenti,Amd.Far

III/b

19820929 200501 2 006

17

Wita Mardiyanti Amd.Kep

III/b

19801025 200501 2 006

18

Yulia Wati,Amd.KL
19790717 200604 2 020

III/b

Ka.UPT Puskesmas
Kasubag TU
Dokter Gigi
Dokter Umum
Perawat Pustu Bukit
Gombak
PNS Fungsional
PNS Fungsional
Bidan Pustu Baringin
PNS Fungsional
Bendahara
Pengeluaran
Pembantu
PNS Fungsional
PNS Fungsional
Bendahara
Penerimaan
Pembantu
PNS Fungsional
Penyimpan barang
PNS Fungsional
PNS Fungsional
PNS Fungsional

TAMBAHAN
PENGHASILAN
5

PENGURANGAN
JAM KERJA
TK /
PAGI SIANG SORE SAKIT
9

JUMLAH
PENGURANGAN
%
Rp.
10

PPh
Pasal 21

DITERIMA

11(9x5)

12(5-10)

13

DITERIMA
BERSIH

TANDA TANGAN

14(11-12)

15

Rp

750,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

750,000

Rp

112,500

Rp

637,500

Rp

565,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

565,000

Rp

28,250

Rp

536,750 2

Rp

500,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

500,000

Rp

25,000

Rp

475,000

Rp

500,000

3.0%

0.0%

0.0%

0.0%

3.0% Rp

15,000

Rp

485,000

Rp

24,250

Rp

460,750 4

,
Rp

300,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

300,000

Rp

15,000

Rp

285,000

Rp

250,000

1.5%

0.0%

0.0%

0.0%

1.5% Rp

3,750

Rp

246,250

Rp

12,313

Rp

233,937 6

Rp

250,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

250,000

Rp

12,500

Rp

237,500

Rp

300,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

300,000

Rp

15,000

Rp

285,000 8

Rp

250,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

250,000

Rp

12,500

Rp

237,500

Rp

560,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

560,000

Rp

28,000

Rp

532,000 10

Rp

250,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

250,000

Rp

12,500

Rp

237,500

Rp

250,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

250,000

Rp

12,500

Rp

237,500 12

Rp

560,000

0.0%

0.0% Rp

Rp

560,000

Rp

28,000

Rp

532,000

Rp

250,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

250,000

Rp

12,500

Rp

237,500 14

Rp

540,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

540,000

Rp

27,000

Rp

513,000

Rp

250,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

250,000

Rp

12,500

Rp

237,500 16

Rp

250,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

250,000

Rp

12,500

Rp

237,500

Rp

250,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

250,000

Rp

12,500

Rp

237,500 18

0.0%

0.0%

0.0%

11

13

15

17

NO
19

NAMA / NIP

GOL

Lucy Hammany,AMK

III/a

19790201 200604 2 018

20

Syri Sandra Fuspaliza,AMK

III/a

19810116 200604 2 012

21

Rika,AMK

III/a

19800929 200701 2 003

22

Sari Febrianita,AMKG

II/c

19870218 200901 2 004

23

Sri Zekiarti

IIIa

19800123 200212 2 005

24

Devi Olivia

III/a

19771006 200701 2 004

25

Mia Oktaviana

II/c

19771006 200701 2 004

26

Veni Z.

II/c

19781007 200701 2 004

27

Syafrizal

II/b

19731017 200701 1 002

28

Marnis

II/a

19781123 200701 2 003

29

Zulharbi
19720412 200701 1 009
J U M LAH

II/a

JABATAN
PNS Fungsional
PNS Fungsional
PNS Fungsional
PNS Fungsional
PNS Fungsional
PNS Fungsional
PNS Fungsional
PNS Fungsional
Staf Puskesmas
Staf Puskesmas
Staf Puskesmas

TAMBAHAN
PENGHASILAN

PENGURANGAN
JAM KERJA
TK /
PAGI SIANG SORE SAKIT

JUMLAH
PENGURANGAN
%
Rp.

DITERIMA
BERSIH

PPh
Pasal 21

DITERIMA

Rp

250,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

250,000

Rp

12,500

Rp

237,500 19

Rp

250,000

3.0%

0.0%

0.0%

0.0%

3.0% Rp

7,500

Rp

242,500

Rp

12,125

Rp

230,375

Rp

250,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

250,000

Rp

12,500

Rp

237,500 21

Rp

220,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

220,000

Rp

Rp

220,000

Rp

250,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

250,000

Rp

12,500

Rp

237,500 23

Rp

250,000

1.5%

0.0%

0.0%

0.0%

1.5% Rp

3,750

Rp

246,250

Rp

12,313

Rp

233,937

Rp

220,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

220,000

Rp

Rp

220,000 25

Rp

220,000

1.5%

0.0%

0.0%

0.0%

1.5% Rp

3,300

Rp

216,700

Rp

Rp

216,700

Rp

335,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

335,000

Rp

Rp

335,000 27

Rp

335,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

335,000

Rp

Rp

335,000

Rp

335,000

0.0%

0.0%

0.0%

0.0%

0.0% Rp

Rp

335,000

Rp

Rp

335,000 29

Rp

9,740,000

Rp

33,300

Rp

9,706,700

Rp

477,251

Rp

TANDA TANGAN

20

22

24

26

28

9,229,449

Terbilang : Sembilan Juta Enam Ratus Dua Puluh Satu Ribu Empat Ratus Dua Puluh Lima Rupiah

Kepala Dinas Kesehatan

Selaku Pengguna Anggaran

Pejabat Penatausahaan Keuangan

Bendahara Pengeluaran

Lima Kaum, 30 April 2016

Ka.UPT Puskesmas Wil.Kerja Lima Kaum I

Dr.Hj.Dasmiwarita M.Kes
NIP. 19600915 198903 2 003

Fitriani,SE,M.Kes
NIP. 19630507 198303 2 001

Herawati,SE
NIP. 19780903 200212 2 002

dr.Hj Susi Julianti

NIP. 19710719 200312 2 001