ACCOUNT STATEMENT

RUMAH SAKIT RAFFLESIA Account No. : 72005233 - RUMAH SAKIT RAFFLESIA

JL MAHONI NO 10 PADANG JATI Account Type : Current
Period : 01-Apr-18 - 23-Apr-18
Page : 1

Posting Date Effective Date Branch Journal Transaction Description Amount DB/CR Balance
Ledger Balance: 41,185,796.00
02/04/2018 10.20.07 02/04/2018 10.20.07 DIVISI 732263 KREDIT LAIN-LAIN | 008 8,054,876.00
0.00 K 49,240,672.00
OPERASIO TRITUNGGAL MAND
NAL PROVIDER
02/04/2018 10.20.07 02/04/2018 10.20.07 DIVISI 732282 KREDIT LAIN-LAIN | 008 216,175.00
0.00 K 49,456,847.00
OPERASIO KARTIKA BINA ME
NAL 611SKeuRSRBII2018
02/04/2018 15.47.49 02/04/2018 15.47.49 DIVISI 624987 KREDIT LAIN-LAIN | 011 1,814,632.00
0.00 K 51,271,479.00
OPERASIO ASURANSI ADIRA
NAL KLAIMPCM 003532038696
02/04/2018 16.54.11 02/04/2018 16.54.11 DIVISI 148730 KREDIT LAIN-LAIN | 008 1,578,333.00
0.00 K 52,849,812.00
OPERASIO TRITUNGGAL MAND -
NAL
02/04/2018 16.54.11 02/04/2018 16.54.11 DIVISI 148740 KREDIT LAIN-LAIN | 031 PT 600,604.00
0.00 K 53,450,416.00
OPERASIO AVRIST ASSUR OP AVRIST
NAL PROVIDER EOB 270318
04/04/2018 11.34.05 04/04/2018 11.34.05 DIVISI 995569 TRANSFER DARI | 11,556,708.00
0.00 K 65,007,124.00
TRANSACTI PEMINDAHAN DARI
ONAL 91540405 BNI LIFE
BANKING INSURANCE PT / CAB. |
SERVICES MAYA YULIAH, RAHMATIN
(TBS) NADIA TRF
TO:000000000072
04/04/2018 13.02.39 04/04/2018 13.02.39 DIVISI 430449 KREDIT LAIN-LAIN | 013 133,755.00
0.00 K 65,140,879.00
OPERASIO ASURANSI ASTRA RS
NAL Rafflesia Bengku/ 00048/04
04/04/2018 13.02.39 04/04/2018 13.02.39 DIVISI 430477 KREDIT LAIN-LAIN | 013 113,525.00
0.00 K 65,254,404.00
OPERASIO ASURANSI ASTRA RS
NAL Rafflesia Bengku/ 00048/04
06/04/2018 10.47.01 06/04/2018 10.47.01 BENGKULU 216312 SETOR TUNAI | Sdr DANIAL 127,381,544.00
0.00 K 192,635,948.00
LIPURA | SETORAN TGL 28-
31/3/2018
06/04/2018 10.47.28 06/04/2018 10.47.28 BENGKULU 223360 SETOR TUNAI | Sdr DANIAL 12,212,516.00
0.00 K 204,848,464.00
LIPURA | SETORAN TGL
01/04/2018
06/04/2018 10.52.23 06/04/2018 10.52.23 BENGKULU 298498 TARIK CHQ 44,957,048.00 D 159,891,416.00
CG025818 | DANIAL
LIPURA/383718559
06/04/2018 11.03.21 06/04/2018 11.03.21 DIVISI 449998 TRANSFER DARI | 3,456,860.00
0.00 K 163,348,276.00
TRANSACTI PEMINDAHAN DARI
ONAL 609888880 LIPPO
BANKING GENERAL INSURANCE |
SERVICES 0072005233
 ACCOUNT STATEMENT
RUMAH SAKIT RAFFLESIA Account No. : 72005233 - RUMAH SAKIT RAFFLESIA
JL MAHONI NO 10 PADANG JATI Account Type : Current
Period : 01-Apr-18 - 23-Apr-18
Page : 2

Posting Date Effective Date Branch Journal Transaction Description Amount DB/CR Balance

(TBS) 20180406457875446 | Lippo

Insurance (05 Apr 2018) |
06/04/2018 13.33.42 06/04/2018 13.33.42 SYARIAH 144383 TRANSFER DARI | 558,726.00
0.00 K 163,907,002.00
JAKARTA KU.26/07/20/JPK.JKT-2018 |
UTARA PEMINDAHAN DARI
8200000899 JKS SIMSEM RS
PELABUHAN JK | PBY
HUTANG YANKES PESERTA
BAPEL JPKM RSP
06/04/2018 15.55.19 06/04/2018 15.55.19 DIVISI 014915 KREDIT LAIN-LAIN | 016 112,125.00
0.00 K 164,019,127.00
OPERASIO ASURANSI SINAR
NAL
09/04/2018 17.38.58 09/04/2018 17.38.58 DIVISI 096234 KREDIT LAIN-LAIN | 016 787,172.00
0.00 K 164,806,299.00
OPERASIO PT.ASURANSI SIN
NAL
09/04/2018 17.38.58 09/04/2018 17.38.58 DIVISI 096250 KREDIT LAIN-LAIN | 008 YKP 347,633.00
0.00 K 165,153,932.00
OPERASIO OJK 621/S.KEU/RSRB
NAL
09/04/2018 18.11.43 09/04/2018 18.11.43 DIVISI 482100 TRANSFER DARI | 18,201,948.00
0.00 K 183,355,880.00
TRANSACTI PEMINDAHAN DARI
ONAL 101407068 BNI LIFE
BANKING INSURANCE.PT | 0072005233
SERVICES 201804091724072500 |
(TBS) HERLINA YULIASTRI
|1485LY10

10/04/2018 10.27.51 10/04/2018 10.27.51 DIVISI 330565 KREDIT LAIN-LAIN | 016 2,850,350.00
0.00 K 186,206,230.00
OPERASIO ASURANSI SINAR
NAL CIPTARINI PURNAMA S
10/04/2018 13.52.10 10/04/2018 13.52.10 DIVISI 139001 KREDIT LAIN-LAIN | 008 PT 3,576,342.00
0.00 K 189,782,572.00
OPERASIO PLN (PERSERO P3BS3
NAL
10/04/2018 15.40.48 10/04/2018 15.40.48 DIVISI 140487 KREDIT LAIN-LAIN | 067 160,062.00
0.00 K 189,942,634.00
OPERASIO ASURANSI ALLIAN 905830-
NAL CLM PAY HLTH FRM ALLIAN
10/04/2018 17.52.55 10/04/2018 17.52.55 DIVISI 344574 TRANSFER DARI | 5,359,802.00
0.00 K 195,302,436.00
TRANSACTI PEMINDAHAN DARI
ONAL 119352653 BNI LIFE
BANKING INSURANCE, PT |
SERVICES 0072005233
(TBS) 201804101099942381 |
BNILIFE PROV
 ACCOUNT STATEMENT
RUMAH SAKIT RAFFLESIA Account No. : 72005233 - RUMAH SAKIT RAFFLESIA
JL MAHONI NO 10 PADANG JATI Account Type : Current
Period : 01-Apr-18 - 23-Apr-18
Page : 3

Posting Date Effective Date Branch Journal Transaction Description Amount DB/CR Balance

|1510LY15
11/04/2018 10.12.15 11/04/2018 10.12.15 DIVISI 137715 KREDIT LAIN-LAIN | 008 279,348.00
0.00 K 195,581,784.00
OPERASIO ASURANSI JIWA I
NAL 901/S.KEU/RSRB/III /2018
11/04/2018 11.48.42 11/04/2018 11.48.42 DIVISI 752352 KREDIT LAIN-LAIN | 067 515,522.00
0.00 K 196,097,306.00
OPERASIO HANJAYA MANDALA
NAL 2500602831,EXCESS MBA
ID804165
11/04/2018 11.48.42 11/04/2018 11.48.42 DIVISI 752365 KREDIT LAIN-LAIN | 067 5,994,279.00
0.00 K 202,091,585.00
OPERASIO HANJAYA MANDALA
NAL MT180403MB162148,PERIAN
SAH-02.
11/04/2018 13.55.28 11/04/2018 13.55.28 DIVISI 795346 KREDIT LAIN-LAIN | 008 FWD 3,107,046.00
0.00 K 205,198,631.00
OPERASIO LIFE INDONE FWD CLAIM
NAL FIN/0668/
11/04/2018 17.36.34 11/04/2018 17.36.34 DIVISI 389977 TRANSFER DARI | 454,897.00
0.00 K 205,653,528.00
TRANSACTI PEMINDAHAN DARI
ONAL 101407068 BNI LIFE
BANKING INSURANCE.PT | 0072005233
SERVICES 201804111506072011 |
(TBS) YUNIARSIH
|0001522.PCLNK56

12/04/2018 09.53.31 12/04/2018 09.53.31 DIVISI 469222 KREDIT LAIN-LAIN | 008 9,331,613.00
0.00 K 214,985,141.00
OPERASIO TRITUNGGAL MAND -
NAL
12/04/2018 16.05.45 12/04/2018 16.05.45 DIVISI 797036 KREDIT LAIN-LAIN | 008 269,654.00
0.00 K 215,254,795.00
OPERASIO SARANA USAHA SE RS
NAL RS
13/04/2018 10.46.24 13/04/2018 10.46.24 BENGKULU 417805 TRANSFER DARI | 1,623,999,600.00
0.00 K 1,839,254,395.00
PEMINDAHAN DARI
2230005671 SIMSEM GIRO
INTERNAL - LAI | BPJS
KESEHATAN
13/04/2018 13.40.59 13/04/2018 13.40.59 BENGKULU 539777 SETOR TUNAI | Sdr DANIAL 77,293,879.00
0.00 K 1,916,548,274.00
LIPURA
13/04/2018 13.52.41 13/04/2018 13.52.41 BENGKULU 725571 TARIK CHQ 897,824,110.00 D 1,018,724,164.00
CG025819 | DANIAL
13/04/2018 16.15.30 13/04/2018 16.15.30 DIVISI 320211 TRANSFER DARI | 2,235,735.00
0.00 K 1,020,959,899.00
TRANSACTI PEMINDAHAN DARI
ONAL 210233968 PT ASURANSI
 ACCOUNT STATEMENT
RUMAH SAKIT RAFFLESIA Account No. : 72005233 - RUMAH SAKIT RAFFLESIA
JL MAHONI NO 10 PADANG JATI Account Type : Current
Period : 01-Apr-18 - 23-Apr-18
Page : 4

Posting Date Effective Date Branch Journal Transaction Description Amount DB/CR Balance

BANKING UMUM MEGA | 0072005233

SERVICES 201804131430729250 |
(TBS) KLAIMHEALTHAUM
|
13/04/2018 16.39.47 13/04/2018 16.39.47 DIVISI 647443 KREDIT LAIN-LAIN | 422 291,450.00
0.00 K 1,021,251,349.00
OPERASIO ASURANSI SINAR PAULA
NAL CORNELIA
13/04/2018 16.39.47 13/04/2018 16.39.47 DIVISI 647451 KREDIT LAIN-LAIN | 008 488,982.00
0.00 K 1,021,740,331.00
OPERASIO ASURANSI BINA D ABDA-
NAL CLAIM 000000000
16/04/2018 09.50.05 16/04/2018 09.50.05 BENGKULU 345422 TRANSFER DARI | 1,309,395,400.00
0.00 K 2,331,135,731.00
PEMINDAHAN DARI
2230005671 SIMSEM GIRO
INTERNAL - LAI | BPJS
KESEHATAN
16/04/2018 10.46.56 16/04/2018 10.46.56 BENGKULU 412237 TARIK CHQ/BG RTGS/FEE 133,658,768.00 D 2,197,476,963.00
CG025820 | BERTHY
SOERACHIM | OPERASIONAL
YAYASAN APRIL 2018

16/04/2018 10.55.22 16/04/2018 10.55.22 BENGKULU 541989 KOR TARIK CHQ/BG 133,658,768.00
0.00 K 2,331,135,731.00
RTGS/CG025820
16/04/2018 10.59.22 16/04/2018 10.59.22 BENGKULU 606622 TARIK CHQ/BG RTGS/FEE 133,658,764.00 D 2,197,476,967.00
CG025820 | BERTHY
SOERACHIM | OPERASIONAL
YAYASAN APRIL 2018

16/04/2018 15.49.33 16/04/2018 15.49.33 DIVISI 652266 KREDIT LAIN-LAIN | 014 PT 282,539.00
0.00 K 2,197,759,506.00
OPERASIO AJ CENTRAL A AF- T.282539
NAL KW NPT.AJ.CAR
17/04/2018 09.37.40 17/04/2018 09.37.40 BENGKULU 149504 TARIK CHQ 267,317,528.00 D 1,930,441,978.00
CG025822 |
DANIAL/383718559
17/04/2018 10.29.51 17/04/2018 10.29.51 DIVISI 052083 KREDIT LAIN-LAIN | 013 193,550.00
0.00 K 1,930,635,528.00
OPERASIO ASURANSI RELIAN RS.
NAL RAFFLESIA RELI
18031429907
17/04/2018 10.29.51 17/04/2018 10.29.51 DIVISI 052106 KREDIT LAIN-LAIN | 008 630,000.00
0.00 K 1,931,265,528.00
OPERASIO ASURANSI SINAR RIO
NAL NICOLAS V
17/04/2018 15.32.58 17/04/2018 15.32.58 BENGKULU 765066 TARIK CHQ/BG 16,144,854.00 D 1,915,120,674.00
BF047239 | PEMINDAHAN KE
 ACCOUNT STATEMENT
RUMAH SAKIT RAFFLESIA Account No. : 72005233 - RUMAH SAKIT RAFFLESIA
JL MAHONI NO 10 PADANG JATI Account Type : Current
Period : 01-Apr-18 - 23-Apr-18
Page : 5

Posting Date Effective Date Branch Journal Transaction Description Amount DB/CR Balance

263666844 PURNA KARYA

MEDIKALINDO , P | PURNA
KARYA
MEDIKALINDO/NOVERWITA
18/04/2018 11.39.43 18/04/2018 11.39.43 BENGKULU 097765 TARIK KLIRING 20,331,361.00 D 1,894,789,313.00
BF047233
18/04/2018 11.41.43 18/04/2018 11.41.43 BENGKULU 128130 TARIK KLIRING 13,009,002.00 D 1,881,780,311.00
BF047232
18/04/2018 11.42.50 18/04/2018 11.42.50 BENGKULU 141784 TARIK KLIRING 8,171,401.00 D 1,873,608,910.00
BF047230
18/04/2018 11.44.20 18/04/2018 11.44.20 BENGKULU 160361 TARIK KLIRING 68,085,991.00 D 1,805,522,919.00
BF047226
18/04/2018 11.46.03 18/04/2018 11.46.03 BENGKULU 182244 TARIK KLIRING 277,480,037.00 D 1,528,042,882.00
BF047241
18/04/2018 12.43.12 18/04/2018 12.43.12 BENGKULU 123924 TARIK CHQ 207,939,452.00 D 1,320,103,430.00
CG025823 | danial lipura
18/04/2018 12.43.58 18/04/2018 12.43.58 DIVISI 133006 KREDIT LAIN-LAIN | 008 896,569.00
0.00 K 1,320,999,999.00
OPERASIO NAYAKA ERA HUSA
NAL
18/04/2018 13.21.32 18/04/2018 13.21.32 BENGKULU 577096 TARIK CHQ 98,812,500.00 D 1,222,187,499.00
CG025812 | AHMAD
SUPRIYADI/0657404326
18/04/2018 14.21.32 18/04/2018 14.21.32 BENGKULU 552038 TARIK CHQ/BG 58,943,650.00 D 1,163,243,849.00
BF047235 | PEMINDAHAN KE
295374864 MEDLAB
NUSANTARA
18/04/2018 16.20.20 18/04/2018 16.20.20 JL 473383 TRANSFER DARI | 1,441,004.00
0.00 K 1,164,684,853.00
PERINTIS PEMINDAHAN DARI
KEMERDEK 269360209904704 |
AAN 0000000000000000 MITRA
YAKES APR2
18/04/2018 16.31.38 18/04/2018 16.31.38 JL 603561 TRANSFER KE | 5,000.00 D 1,164,679,853.00
PERINTIS PEMINDAHAN KE
KEMERDEK 269360209904704 |
AAN 0269360209904704 BIAYA
MITRA APR 02
19/04/2018 11.23.57 19/04/2018 11.23.57 BENGKULU 296541 TRANSFER KE | 100,000.00 D 1,164,579,853.00
PEMINDAHAN KE
223360193104012 | RUMAH
SAKIT RAFFLESIA
BENGKULU
 ACCOUNT STATEMENT
RUMAH SAKIT RAFFLESIA Account No. : 72005233 - RUMAH SAKIT RAFFLESIA
JL MAHONI NO 10 PADANG JATI Account Type : Current
Period : 01-Apr-18 - 23-Apr-18
Page : 6

Posting Date Effective Date Branch Journal Transaction Description Amount DB/CR Balance

19/04/2018 11.42.01 19/04/2018 11.42.01 DIVISI 535654 KREDIT LAIN-LAIN | 008 7,500,000.00
0.00 K 1,172,079,853.00
OPERASIO BERTHY SOERACHI
NAL PENGEMBELIAN UANG
AMBULANCE
19/04/2018 12.05.51 19/04/2018 12.05.51 BENGKULU 065848 TARIK KLIRING 15,019,137.00 D 1,157,060,716.00
BF047228
19/04/2018 12.07.17 19/04/2018 12.07.17 BENGKULU 084685 TARIK KLIRING 8,670,530.00 D 1,148,390,186.00
BF047240
19/04/2018 12.07.39 19/04/2018 12.07.39 BENGKULU 089741 TARIK KLIRING 31,110,440.00 D 1,117,279,746.00
BF047229
19/04/2018 12.10.16 19/04/2018 12.10.16 BENGKULU 122425 TARIK KLIRING 73,968,792.00 D 1,043,310,954.00
BF047231
19/04/2018 15.02.11 19/04/2018 15.02.11 BENGKULU 626389 TARIK CHQ/BG 7,707,370.00 D 1,035,603,584.00
BF047237 | PEMINDAHAN KE
70568968 MILLENNIUM
PHARMACON INTERNA |
MILLENNIUM PHARMACON
INTERNATIONAL
20/04/2018 10.48.23 20/04/2018 10.48.23 DIVISI 163327 KREDIT LAIN-LAIN | 008 132,123.00
0.00 K 1,035,735,707.00
OPERASIO ASURANSI JIWA I
NAL 1358/S.KEU/RSRB/IV /2018
20/04/2018 11.23.43 20/04/2018 11.23.43 BENGKULU 630748 SETOR TUNAI | Sdr ERWIN 130,674,790.00
0.00 K 1,166,410,497.00
SAHADI
20/04/2018 11.26.16 20/04/2018 11.26.16 BENGKULU 667842 TARIK CHQ CF995226 109,396,135.00 D 1,057,014,362.00
| ERWIN
20/04/2018 11.31.40 20/04/2018 11.31.40 BENGKULU 737184 TARIK CHQ 89,888,916.00 D 967,125,446.00
CG025825 | ERWIN
20/04/2018 11.35.58 20/04/2018 11.35.58 BENGKULU 788194 TARIK KLIRING 10,137,199.00 D 956,988,247.00
BF047227
20/04/2018 11.49.39 20/04/2018 11.49.39 MELAWAI 181815 SETOR TUNAI | PT GLOBAL 167,000.00
0.00 K
RAYA ASSITANCE
Ending Balance : 957,155,247.00

Total Debet : 24 2,592,337,985.00

Total Credit : 43 3,508,307,436.00