LAPORAN BELANJA DANA KAPIT

FKTP

PUSKESMAS TELAGA
URAIAN

JAN

PAGU DPA JKN

1. JASA PELAYANAN

Rp

2. OPERASIONAL

Rp

* Belanja Obat-obatan

Rp

33,648,000

* Belanja BHP Medis

Rp

24,800,000

Rp

16,000,000

* BBM Rujukan

Rp

12,000,000

* Belanja Suku Cadang

Rp

10,000,000

* Belanja Cetak

Rp

23,000,000

* Belanja Alat Tulis Kantor

Rp

12,800,000

* Perdis dalam Daerah

Rp

52,000,000

* Belanja Pengadaan ALKES

3. Biaya Pajak
4. BIAYA ADM. BANK

Rp

Rp

1,475,097

184,248,000

PEB

MRT

APRL

MEI

Rp
Rp

JUN

8,657
3,000

Rp

35,046,000

Rp

1,559,600

Rp

2,160,000

Rp

980,000

Rp

480,000

Rp

13,000,000

Rp
Rp

23,813
3,000

Rp

53,249,413

A DANA KAPITASI JKN TAHUN 2014

JUL
Rp

AGST

35,040,600

Rp

SEPT

35,285,400

Rp

1,375,000

Rp

200,000

Rp

1,977,500

Rp

9,142,000

Rp

OKT

35,440,200

Rp

NOP

35,073,000

Rp

892,500

Rp

1,469,000

Rp

930,000

Rp

500,000

Rp

725,000

Rp

Rp

DES

35,116,200

JUMLAH

Rp

34,954,200

Rp

34,990,200

Rp

174,000

407,640

Rp

1,721,381

Rp

2,765,500

Rp

1,476,000

Rp

2,615,000

Rp

2,485,000

Rp

550,000

Rp

650,000

Rp

9,480,000

Rp

640,000

Rp

1,000,000

Rp

480,000

Rp

2,160,000

Rp

898,500

Rp

Rp

975,000

Rp

790,000

Rp

245,955,600

Rp

2,641,500

Rp

15,485,740

Rp

3,385,000

Rp

5,962,881

Rp

7,280,000

Rp

14,240,000

Rp

2,663,500

Rp

32,500,000

Rp

6,500,000

Rp

6,500,000

Rp

6,500,000

Rp

Rp
Rp

9,687
3,000

Rp
Rp

5,654
3,000

Rp
Rp

8,679
3,000

Rp
Rp

13,536
3,000

Rp
Rp

14,217
3,000

Rp
Rp

18,275
3,000

Rp
Rp

102,518
24,000

Rp

58,722,168

Rp

57,026,554

Rp

47,845,379

Rp

38,767,036

Rp

38,676,057

Rp

70,929,675

Rp

84,158,621

Rp

365,216,282
103,703,579

Limboto,
Desember 2014
KEPALA FKTP PUSKESMAS TELAGA

HERIYANTO PALILATI,SKM,M.Kes
Nip. 197107311991031003

KET.

Rp

LAPORAN PENDAPATAN DANA KAPITASI JKN TAHUN 2014

FKTP

: PUSKESMAS TELAGA BIRU

URAIAN

JAN

KAPITASI JKN

Rp

PEND. BUNGA BANK

Rp

JUMLAH

PEB

123,690,000

Rp

- Rp

Rp 123,690,000

MRT

124,314,000

APRL

Rp

124,584,000

- Rp

Rp 124,314,000

Rp 124,584,000

Rp 104,025,000

MEI
Rp 104,230,000 Rp

### Rp
Rp104,025,000

JUN

82,796 Rp

Rp104,312,796

JUL

AGST

104,315,000

Rp

104,115,000

Rp

103,850,000

209,609

Rp

193,689

Rp

164,992

Rp 104,524,609

Rp 104,308,689

Rp 104,014,992

N 2014

SEPT

OKT

NOP

Rp

102,505,000

Rp

100,365,000

Rp

98,435,000

Rp

207,112

Rp

273,315

Rp

343,584

Rp 102,712,112

Rp 100,638,315 Rp

DES
Rp

98,778,584 Rp

97,455,000

JUMLAH
Rp1,291,883,000
Rp

97,455,000

1,475,097

Rp1,293,358,097

Limboto,
Desember 2014
KEPALA FKTP PUSKESMAS TELAGA BIRU

Mohamad K. Yunus, SKMM.Kes.

Nip. 19630413 198412 00 1
Rp 1,475,097

FKTP

: PUSKESMAS TELAGA BIRU

URAIAN

PAGU DPA JKN

DANA MASUK REK.

1. JASA PELAYANAN

Rp

464,488,200

Rp

489,162,000

2. OPERASIONAL
* Belanja Obat-obatan
* Belanja BHP Medis
* Belanja Pengadaan ALKES
* Belanja Perjalanan Dinas

Rp

309,658,800

Rp

326,108,000

BBM Puskesmas Keliling

Belanja Pelumas
Belanja Suku Cadang
Belanja Cetak

Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp

24,772,704
24,772,704
74,318,112
91,929,000
23,200,000
3,200,000
6,000,000
28,565,600

* Belanja Alat Tulis Kantor

Rp

32,900,680

3. BIAYA ADM. BANK

Rp

1,475,097

*
*
*
*

LAPORAN BELANJA DANA KAPITAS

JAN
Rp

PEB
-

###

MRT
Rp

APRL
-

Rp

MEI
-

Rp 62,538,000

Rp

4,046,037

Rp

82,796

JA DANA KAPITASI JKN TAHUN 2014

JUN

JUL

AGST

SEPT

OKT

Rp 62,589,000

Rp 62,469,000

Rp 62,310,000

Rp 61,503,000

Rp 60,219,000

Rp
Rp
Rp
Rp

Rp

209,609

5,490,000

Rp

4,014,556

Rp

193,689

Rp

Rp

2,723,500
5,998,500
8,549,000
Rp

975,000

Rp

273,315

1,600,000

164,992

Rp
Rp

5,625,000
4,117,156

Rp

207,112

NOP

DES

Rp 59,061,000

Rp 58,473,000

Rp
Rp

Rp

775,000
3,750,000

343,584

JUMLAH

Rp
Rp

3,953,000
1,610,000

Rp
Rp

6,725,000
1,250,000

Rp

575,000

Rp

SELISIH LEBIH

489,162,000 Rp

24,673,800

Rp

16,449,200

Rp
Rp
Rp
Rp
Rp

6,676,500
7,608,500
8,549,000
8,475,000
12,090,000

Rp
Rp
Rp

575,000
5,625,000
12,177,749

Rp

1,475,097

Limboto,
Desember 2014
KEPALA FKTP PUSKESMAS TELAGA BIRU

Mohamad K. Yunus, SKMM.Kes.

Nip. 19630413 198412 00 1

KET.

LAPORAN PEMOTONGAN & PENYETORAN P

FKTP
URAIAN

JAN

PEB

MRT

APRL

MEI

PPn.

Rp

### Rp

Rp

- Rp

367,812

PPh. Psl 21

Rp

### Rp

Rp

- Rp

1,761,058

PPh. Psl 22

Rp

Rp

Rp

Rp

- Rp

110,346

PPh. Psl 23

Rp

Rp

Rp

Rp

JUMLAH

MOTONGAN & PENYETORAN PAJAK ATAS DANA KAPITASI JKN TAHUN 2014

JUN

JUL

AGST

SEPT

OKT

Rp 1,835,223

Rp 1,825,058

Rp 1,695,902

Rp 2,010,479

Rp 1,985,470

Limboto,
Desember 2014
KEPALA FKTP PUSKESMAS TELAGA BIRU

Mohamad K. Yunus, SKMM.Kes.

Nip. 19630413 198412 00 1

2014

NOP

DES

Rp 1,762,317

Rp 1,756,202

to,
Desember 2014
P PUSKESMAS TELAGA BIRU

ad K. Yunus, SKMM.Kes.
19630413 198412 00 1

JUMLAH

Rp

14,631,709

LAPORAN BELANJA DANA KAPITASI JKN T

FKTP

PUSKESMAS TELAGA
URAIAN

JAN

PAGU DPA JKN

1. JASA PELAYANAN

Rp

2. OPERASIONAL

Rp

* Belanja Obat-obatan

Rp

33,648,000

* Belanja BHP Medis

Rp

24,800,000

Rp

16,000,000

* BBM Rujukan

Rp

12,000,000

* Belanja Suku Cadang

Rp

10,000,000

* Belanja Cetak

Rp

23,000,000

* Belanja Alat Tulis Kantor

Rp

12,800,000

* Perdis dalam Daerah

Rp

52,000,000

3. BIAYA ADM. BANK

Rp

1,475,097

* Belanja Pengadaan ALKES

Rp

184,248,000

PEB

MRT

APRL

MEI

JUN
Rp

35,046,000

Rp

1,559,600

Rp

2,160,000

JUL
Rp

35,040,600

Rp

1,375,000

Rp

1,412,500

Rp

1,721,381

Rp

980,000

Rp

2,615,000

Rp

480,000

Rp

9,480,000

Rp

13,000,000

Rp

6,500,000

Rp

53,225,600

Rp

58,144,481

SI JKN TAHUN 2014

AGST
Rp

35,285,400

Rp

200,000

Rp

9,142,000

SEPT
Rp

35,440,200

OKT
Rp

NOP

35,073,000

Rp

892,500

Rp

1,469,000

Rp

930,000

Rp

500,000

Rp

725,000

Rp

Rp

35,116,200

2,765,500

Rp

1,476,000

Rp

2,485,000

Rp

550,000

Rp

650,000

Rp

640,000

Rp

1,000,000

Rp

480,000

Rp

2,160,000

Rp

898,500

Rp

Rp

975,000

6,500,000

Rp

6,500,000

Rp

Rp

57,017,900

Rp

47,833,700 Rp

38,750,500 Rp

753,900
410,000
1,163,900

Rp

34,954,200

Rp

34,990,200

Rp

174,000

38,658,840

Rp

Rp

JUMLAH
Rp

KET.

245,955,600

Rp

280,945,800

Rp

2,641,500

Rp

14,920,740

Rp

3,385,000

Rp

5,962,881

Rp

7,280,000

Rp

14,240,000

Rp

2,663,500

Rp

1,538,400

Rp

32,500,000

Rp

1,125,100

Rp

83,593,621

Rp
468,243,000 Rp
Rp
Rp

364,539,421
103,703,579
103,703,579
-

407,640

Rp

Rp

DES

790,000

70,908,400

Uang ditangan

58,001,591

uang ditangan
45,701,988

UANG TUNAI
Listrik
Pajak
non kapitasi
uang hilang
pinj.utk dikes
BBM yang tdk
ada nota
PERDIS
Listrik yg tdk d
tukar APBD
Oktbr-Des
Air Agusts

6,940,000
8,060,000
10,000,000
1,000,000
4,500,000

12,500,000

4,830,400
739,000
36,069,400

4,830,400

UANG YANG HARUS ADA

6,700,000

19,200,000

Rp

21,027,600

Rp

31,006,500

Rp

9,879,260

Rp

12,615,000

Rp

6,037,119

Rp

2,720,000

Rp

8,760,000

Rp

10,136,500

Rp

19,500,000
Rp

Rp

58,001,591
58,001,591

LAPORAN PENDAPATAN DANA KAPITASI JKN TAHUN 2014

FKTP

: PUSKESMAS TELAGA

URAIAN

JAN

PEB

KAPITASI JKN

Rp

56,496,000

PEND. BUNGA BANK

Rp

JUMLAH

Rp

56,496,000

Rp

MRT

57,057,000

Rp

### Rp

Rp

57,057,000

Rp

APRL

57,198,000 Rp

Rp

57,198,000 Rp

MEI

JUN

JUL

AGST

57,846,000

Rp

58,410,000 Rp

58,401,000

Rp

58,809,000

Rp

59,067,000

Rp

43,297 Rp

119,119

Rp

48,423

Rp

29,209

58,520,119

Rp

58,857,423

Rp

59,096,209

57,846,000 Rp

58,453,297

Rp

N TAHUN 2014

SEPT

Rp

Rp

Rp

OKT

58,455,000

44,414

58,499,414

Rp

Rp

Rp

58,527,000

67,714

NOP

Rp

Rp

58,594,714 Rp

58,317,000

71,126

DES

Rp

Rp

58,388,126 Rp

58,257,000

JUMLAH

Rp

91,377 Rp

58,348,377

Rp

696,840,000

Rp

468,243,000

Rp

187,297,200

Rp

228,597,000

514,679

697,354,679

Limboto,
Desember 2014
KEPALA FKTP PUSKESMAS TELAGA

HERIYANTO PALILATI,SKM,M.Kes
Nip. 197107311991031003
Rp 1,475,097

LAPORAN BELANJA DANA KAPITASI JKN TAH

FKTP

PUSKESMAS TELAGA
URAIAN

JAN

PAGU DPA JKN

1. JASA PELAYANAN

Rp

2. OPERASIONAL

Rp

* Belanja Obat-obatan

Rp

33,648,000

* Belanja BHP Medis

Rp

24,800,000

Rp

16,000,000

* BBM Rujukan

Rp

12,000,000

* Belanja Suku Cadang

Rp

10,000,000

* Belanja Cetak

Rp

23,000,000

* Belanja Alat Tulis Kantor

Rp

12,800,000

* Perdis dalam Daerah

Rp

52,000,000

3. BIAYA ADM. BANK

Rp

1,475,097

* Belanja Pengadaan ALKES

PEB

MRT

APRL

MEI
Rp

Rp

Rp

Rp

JUN
-

Rp

35,046,000

Rp

1,559,600

Rp

2,160,000

JUL
Rp

35,040,600

Rp

1,375,000

Rp

1,412,500

Rp

1,721,381

Rp

980,000

Rp

2,615,000

Rp

480,000

Rp

9,480,000

Rp

13,000,000

Rp

6,500,000

Rp

53,225,600

Rp

58,144,481

KAPITASI JKN TAHUN 2014

AGST
Rp

35,285,400

Rp

200,000

Rp

9,142,000

SEPT
Rp

35,440,200

OKT
Rp

NOP

35,073,000

Rp

892,500

Rp

1,469,000

Rp

930,000

Rp

500,000

Rp

725,000

Rp

Rp

35,116,200

2,765,500

Rp

1,476,000

Rp

Rp

2,485,000

Rp

550,000

Rp

650,000

Rp

640,000

Rp

1,000,000

Rp

480,000

Rp

2,160,000

Rp

898,500

Rp

Rp

410,000

Rp

6,500,000

Rp

Rp

6,500,000

57,017,900

Rp

47,833,700

Rp

38,750,500

Rp

JUMLAH

Rp

34,954,200

Rp

280,945,800

Rp

34,990,200

Rp

174,000

Rp

2,641,500

Rp

14,920,740

Rp

3,385,000

Rp

5,962,881

Rp

7,280,000

Rp

14,240,000

Rp

2,098,500

Rp

32,500,000

70,908,400 Rp

83,028,621

407,640

Rp

Rp

Rp

DES

38,093,840

Rp

Rp

Rp

790,000

KET.

Limboto,
Desember 2014
KEPALA FKTP PUSKESMAS TELAGA

HERIYANTO PALILATI,SKM,M.Kes
Nip. 197107311991031003

LAPORAN PEMOTONGAN & PENYETORAN PAJAK ATAS DANA KAPITASI JKN TAHUN 2014
FKTP
URAIAN

PUSKESMAS TELAGA
JAN

PEB

MRT

APRL

MEI

PPn.

Rp -

Rp -

Rp

- Rp

PPh. Psl 21

Rp -

Rp -

Rp

- Rp

- Rp

PPh. Psl 22

Rp -

Rp -

Rp

- Rp

PPh. Psl 23

Rp -

Rp -

Rp

- Rp

JUN

Rp
1,596,412

JUL

AGST

175,000

Rp 1,135,909

Rp

Rp 1,597,439

Rp 1,609,760

Rp 1,617,358

Rp

Rp

Rp

26,250

170,386

SEPT

OKT

NOP

Rp 1,557,150

Rp 1,567,282

Rp 1,564,754

229,091

34,364

JUMLAH
Limboto,
Desember 2014
KEPALA FKTP PUSKESMAS TELAGA

HERIYANTO PALILATI,SKM,M.Kes
Nip. 197107311991031003

DES

Rp 1,679,151

ber 2014
MAS TELAGA

SKM,M.Kes
1031003

JUMLAH

Rp

1,540,000

Rp

12,789,306

Rp

231,000

Rp 14,560,306

NOTA YANG TIDAK SESUAI JUKNIS

Bayar biaya peralatan kebersihan selang Bulan Mei
Bayar biaya peralatan kebersihan selang Bulan Mei
Bayar biaya peralatan kebersihan selang Bulan Juni
Bayar biaya bahan kebersihan sept
Bayar biaya Finger absensi
Bayar biaya printer
Bayar biaya perlengkapan komputer
Bayar koran
Bayar biaya MCB untuk ruangan TU
Biaya F.Kopi
Bayar perbaikan kunci lamari
Biaya F.Kopi spj JKN
Listrik yg tdk d tukar APBD Oktbr-Des
Air Agusts
Bayar f.kopi spj JKN an Uci
Bayar basi kase bae kunci
Bayar nota Kapus(lape2 kunci)
Bayar BBM Genset an Wawan
Bayar BBM 1064 B an Wawan ambil obat
Bayar F.Kopi SPJ JKN
Bayar F.Kopi SPJ JKN + Map
Bayar BBM 1130 B ke GM Batudaa Pantai
An Arfan B.
Bayar F.Kopi SPJ JKN
Transport yanti ke Inspektorat Provinsi
Bayar
Bayar
Bayar
Bayar
Bayar

BBM untuk Genset an Ridwan

BBM 1064 B an Ridwan
BBM an Wawan
ganti MCB AC di ruangan TU
sm Uyun uang ATK

Bayar Nota Ayu (sumbangan Kec.)

F kopi spj JKN ke polisi
Cuci foto konsul
Transport minta cap spj + materai
Jumlah Sampai dengan bulan ini

#REF!

Rp

242,300

Rp

56,550

Rp

45,200

Rp

8,775

Rp

2,250,000

Rp

950,000

Rp

280,000

Rp

270,000

PERDIS

Rp

100,000

bayar listrik

Rp

2,000

Rp

300,000

Rp

205,800

Rp
Rp

4,830,400
739,000
34,000
50,000
250,000
50,000
200,000
5,800
200,000
100,000
2,000
100,000
50,000
100,000
100,000
100,000
1,300,000
85,000

Rp

48,000
200,000
350,000
13,604,825

Nota tdk sesuai juknis

Pajak
non kapitasi
uang hilang
Kapus
BBM yang tdk ada nota

total
Uang ditangan

13,604,825
6,940,000
8,060,000
10,000,000
1,000,000
3,000,000
2,150,000
44,754,825
58,001,591
13,246,766

12,500,000