Insentif 2017

DAFTAR : NAMA - NAMA PNS RSUD Dr.
PIRNGADI KOTA MEDAN YANG MENERIMA

INSENTIF BERDASARKAN FUNGSI TEHNIS
UNIT KERJA : SUBBAG KEPEGAWAIAN
BULAN : JANUARI 2017
==================================================================
JUMLAH PPH. 21
JUMLAH JUMLAH BULAN JUMLAH KOTOR JUMLAH TANDA
NO NAMA / NIP NPWP GOL ESELON JABATAN PENGURANGAN
BULAN (Rp.) (Rp)
(Rp) BERSIH (Rp) TANGAN
5% 15% 20%
1 Irma Yani, S.Sos 69.569.372.1-113.000 III/d IV.a Kasubbag Kepegawaian 1 Rp 1,650,000 Rp - Rp 1,650,000 Rp 82,500 - - Rp 1,567,500
NIP. 19661103 198803 2 004 RSUD Dr. Pirngadi Kota Medan

2 Dormini Situmorang, S.Psi 69.142.926.0-115-000 III/d - Staf 1 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 - - Rp 1,140,000
NIP. 19660903 198503 2 001

3 Idhamsyah, S.Sos 77.249.107.2.113.000 III/d - Staf 1 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 - - Rp 1,140,000
NIP. 19771002 199602 1 001

4 Rohani Br. Sembiring 79.797.602.4-113.000 III/d - Staf 1 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 - - Rp 1,140,000
NIP. 19670403 200801 2 001

5 Noliana, SE 48.280.512.4-113.000 III/c - Staf 1 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 - - Rp 1,140,000
NIP. 19630109 199303 2 004
6 Rosmawati Banuarea 48.280.572.8-113.000 III/b - Staf 1 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 - - Rp 1,140,000
NIP. 19630725 198402 2 001

7 Arfah 48.280.452.3-113.000 III/b - Staf 1 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 - - Rp 1,140,000
NIP. 19650416 199108 2 001

8 Florida Pane, SE 67.665.317.3-113.000 III/b - Staf 0 Rp - Rp - Rp - Rp - - - Rp -
NIP. 19780709 200804 2 001

9 Fransiska Isabella, SE 36.463.271.1-121.000 III/a - Staf 1 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 - - Rp 1,140,000
NIP. 19830217 201001 2 028
10 Nurwuri Handayani, S.Sos 79.797.395.5-113.000 III/a - Staf 1 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 - - Rp 1,140,000
NIP. 19800131 200801 2 006
1
JUMLAH PPH. 21
JUMLAH JUMLAH BULAN JUMLAH KOTOR JUMLAH TANDA
BULAN (Rp.) (Rp)
5% 15% 20%
11 H u m a i d a - II/d Staf 1 Rp 1,200,000 Rp - Rp 1,200,000 Rp - - - Rp 1,200,000
NIP, 19631012 199203 2 004
12 Rudianto - II/c - Staf 1 Rp 1,200,000 Rp - Rp 1,200,000 Rp - - - Rp 1,200,000
NIP. 19670403 200801 1 001

13 S u m i a t y - II/b - Staf 1 Rp 1,200,000 Rp - Rp 1,200,000 Rp - - - Rp 1,200,000
NIP. 19600620 198101 2 002

J U M LAH Rp 14,850,000 Rp - Rp 14,850,000 Rp 562,500 Rp - Rp- Rp 14,287,500
CATATAN :
PPH 21 :
- Gol. : III = 5%
- Gol. : IV = 15%
Bagi yang tidak mempunyai NPWP 20%
Diketahui : Medan, 2017
Bend. Pengeluaran Direktur Juru Bayar

RSUD Dr. Pirngadi Kota Medan RSUD Dr. Pirngadi Kota Medan RSUD Dr. Pirngadi Kota Medan
Abdul Rahim Situmorang, SE Dr. H. Edwin Effendi, M.Sc Beslina Malau

NIP. 19860712 201101 1 020 NIP. 19610815 198710 1 001 NIP. 19680820 199008 2 001
2
DAFTAR : NAMA - NAMA PNS RSUD Dr. PIRNGADI KOTA MEDAN YANG MENERIMA
INSENTIF BERDASARKAN BEBAN KERJA
UNIT KERJA : SUBBAG KEPEGAWAIAN
BULAN : JANUARI 2017
==================================================================
JUMLAH JUMLAH BULAN JUMLAH

JUMLAH KOTOR
PPH. 21 JUMLAH TANDA
BULAN (Rp.) (Rp)
5% 15% 20%
1 Irma Yani, S.Sos 69.569.372.1-113.000 III/d IV.a Kasubbag Kepegawaian 1 Rp 1,500,000 Rp - Rp 1,500,000 Rp 75,000 - - Rp 1,425,000
NIP. 19661103 198803 2 004 RSUD Dr. Pirngadi Kota Medan

2 Dormini Situmorang, S.Psi 69.142.926.0-115-000 III/d - Staf 1 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 - - Rp 950,000
NIP. 19660903 198503 2 001

3 Idhamsyah, S.Sos 77.249.107.2.113.000 III/d - Staf 1 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 - - Rp 950,000
NIP. 19771002 199602 1 001
4 Rohani Br. Sembiring 79.797.602.4-113.000 III/d - Staf 1 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 - - Rp 950,000
NIP. 19670403 200801 2 001

5 Noliana, SE 48.280.512.4-113.000 III/c - Staf 1 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 - - Rp 950,000
NIP. 19630109 199303 2 004

6 Rosmawati Banuarea 48.280.572.8-113.000 III/b - Staf 1 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 - - Rp 950,000
NIP. 19630725 198402 2 001

7 Arfah 48.280.452.3-113.000 III/b - Staf 1 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 - - Rp 950,000
NIP. 19650416 199108 2 001
8 Florida Pane, SE 67.665.317.3-113.000 III/b - Staf 0 Rp - Rp - Rp - Rp - - - Rp -
NIP. 19780709 200804 2 001

9 Fransiska Isabella, SE 36.463.271.1-121.000 III/a - Staf 1 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 - - Rp 950,000
NIP. 19830217 201001 2 028

10 Nurwuri Handayani, S.Sos 79.797.395.5-113.000 III/a - Staf 1 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 - - Rp 950,000
NIP. 19800131 200801 2 006
11 H u m a i d a - II/d Staf 1 Rp 750,000 Rp - Rp 750,000 - - - Rp 750,000
3
JUMLAH JUMLAH BULAN JUMLAH
JUMLAH KOTOR
PPH. 21 JUMLAH TANDA
BULAN (Rp.) (Rp)
5% 15% 20%
NIP, 19631012 199203 2 004

12 Rudianto - II/c - Staf 1 Rp 750,000 Rp - Rp 750,000 - - - Rp 750,000
NIP. 19670403 200801 1 001

13 S u m i a t y - II/b - Staf 1 Rp 750,000 Rp - Rp 750,000 - - - Rp 750,000
NIP. 19600620 198101 2 002
J U M LAH Rp 11,750,000 Rp - Rp 11,750,000 Rp 475,000 - - Rp 11,275,000
CATATAN :
PPH 21 :
- Gol. : III = 5%
- Gol. : IV = 15%
Bagi yang tidak mempunyai NPWP 20%
Diketahui : Medan, 2017
Bend. Pengeluaran Direktur Juru Bayar

RSUD Dr. Pirngadi Kota Medan RSUD Dr. Pirngadi Kota Medan RSUD Dr. Pirngadi Kota Medan
Abdul Rahim Situmorang, SE Dr. H. Edwin Effendi, M.Sc Beslina Malau

NIP. 19860712 201101 1 020 NIP. 19610815 198710 1 001 NIP. 19680820 199008 2 001
4
DAFTAR PENERIMAAN TAMBAHAN PENGHASILAN BERDASARKAN BEBAN KERJA (FUNGSI PELAKSANA TEKNIS)
STAF SUBBAG KEPEGAWAIAN RSUD Dr. PIRNGADI KOTA MEDAN
UNTUK BULAN PEBRUARI 2017
==================================================================================================
JLH U. F. PELK. TEKNIS JLH. UANG F. PELK. JUMLAH PPH. 21 JUMLAH UANG
NO NAMA / NIP NPWP GOL/ ESL BLN PER BULAN TEKNIS PENGURANGAN
JUMLAH BRUTO
DITERIMA
TANDA TANGAN
5% 15% 20%
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 Irma Yani, S.Sos 69.569.372.1-113.000 III/d / 1 Rp 1,650,000 Rp 1,650,000 Rp - Rp 1,650,000 Rp 82,500 Rp - Rp - Rp 1,567,500 1
Kasubbag
NIP. 19661103 198803 2 004 Kepegawaian
2 Dormini Situmorang, S.Psi 69.142.926.0-115-000 III/d 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 Rp - Rp - Rp 1,140,000 2
NIP. 19660903 198503 2 001
3 Idhamsyah, S.Sos 77.249.107.2.113.000 III/d 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 Rp - Rp - Rp 1,140,000 3
NIP. 19771002 199602 1 001
4 Rohani Br. Sembiring 79.797.602.4-113.000 III/d 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 Rp - Rp - Rp 1,140,000 4
NIP. 19670403 200801 2 001
5 Noliana, SE 48.280.512.4-113.000 III/c 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 Rp - Rp - Rp 1,140,000 5
NIP. 19630109 199303 2 004
6 Rosmawati Banuarea 48.280.572.8-113.000 III/b 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 Rp - Rp - Rp 1,140,000 6
NIP. 19630725 198402 2 001
7 Arfah 48.280.452.3-113.000 III/b 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 Rp - Rp - Rp 1,140,000 7
NIP. 19650416 199108 2 001
8 Florida Pane, SE 67.665.317.3-113.000 III/b 0 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 Rp - Rp - Rp 1,140,000 8
NIP. 19780709 200804 2 001
9 Fransiska Isabella, SE 36.463.271.1-121.000 III/a 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 Rp - Rp - Rp 1,140,000 9
NIP. 19830217 201001 2 028
10 Nurwuri Handayani, S.Sos 79.797.395.5-113.000 III/a 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 Rp - Rp - Rp 1,140,000 10
NIP. 19800131 200801 2 006
5
1 2 3 4 5 6 7 8 9 10 11 12 13 14
11 H u m a i d a - II/d 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 - Rp - Rp - Rp 1,200,000 11
NIP. 19631012 199203 2 004
12 Firman Lubis, Amd - II/d 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 - Rp - Rp - Rp 1,200,000 12
NIP. 19840904 201001 1 013

13 Rudianto - II/c 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 - Rp - Rp - Rp 1,200,000 13
NIP. 19670403 200801 1 001
14 S u m i a t y - II/b 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 - Rp - Rp - Rp 1,200,000 14
NIP. 19600620 198101 2 002
JUMLAH Rp 17,250,000 Rp - Rp 17,250,000 Rp 622,500 Rp - Rp - Rp 16,627,500
Medan, Maret 2017
Kasubbag Kepegawaian
RSUD Dr. Pirngadi Kota Medan
Irma Yani, S.Sos

NIP. 19661103 198803 2 004
6
DAFTAR PENERIMAAN TAMBAHAN PENGHASILAN BERDASARKAN BEBAN KERJA (UANG KESEJAHTERAAN)
UNTUK BULAN PEBRUARI 2017
==================================================================================================
GOL/ JLH U. KESEJAHTERAAN JLH. UANG JUMLAH

PPH. 21 JUMLAH UANG
NO NAMA / NIP NPWP PER BULAN
JUMLAH BRUTO TANDA TANGAN
ESL BLN KESEJAHTERAAN PENGURANGAN
5% 15% 20%
DITERIMA
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 Irma Yani, S.Sos 69.569.372.1-113.000 III/d/ 1 Rp 1,500,000 Rp 1,500,000 Rp - Rp 1,500,000 Rp 75,000 Rp - Rp - Rp 1,425,000 1
NIP. 19661103 198803 2 004 IV.a
2 Dormini Situmorang, S.Psi 69.142.926.0-115-000 III/d 1 Rp 1,000,000 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 Rp - Rp - Rp 950,000 2
NIP. 19660903 198503 2 001
3 Idhamsyah, S.Sos 77.249.107.2.113.000 III/d 1 Rp 1,000,000 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 Rp - Rp - Rp 950,000 3
NIP. 19771002 199602 1 001
4 Rohani Br. Sembiring 79.797.602.4-113.000 III/d 1 Rp 1,000,000 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 Rp - Rp - Rp 950,000 4
NIP. 19670403 200801 2 001
5 Noliana, SE 48.280.512.4-113.000 III/c 1 Rp 1,000,000 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 Rp - Rp - Rp 950,000 5
NIP. 19630109 199303 2 004
6 Rosmawati Banuarea 48.280.572.8-113.000 III/b 1 Rp 1,000,000 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 Rp - Rp - Rp 950,000 6
NIP. 19630725 198402 2 001
7 Arfah 48.280.452.3-113.000 III/b 1 Rp 1,000,000 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 Rp - Rp - Rp 950,000 7
NIP. 19650416 199108 2 001
8 Florida Pane, SE 67.665.317.3-113.000 III/b 0 Rp 1,000,000 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 Rp - Rp - Rp 950,000 8
NIP. 19780709 200804 2 001

9 Fransiska Isabella, SE 36.463.271.1-121.000 III/a 1 Rp 1,000,000 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 Rp - Rp - Rp 950,000 9
NIP. 19830217 201001 2 028

10 Nurwuri Handayani, S.Sos 79.797.395.5-113.000 III/a 1 Rp 1,000,000 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 Rp - Rp - Rp 950,000 10
NIP. 19800131 200801 2 006

11 H u m a i d a - II/d 1 Rp 750,000 Rp 750,000 Rp - Rp 750,000 - Rp - Rp - Rp 750,000 11
NIP. 19631012 199203 2 004
7
PPH. 21 JUMLAH UANG
5% 15% 20%
DITERIMA
12 Firman Lubis, Amd - II/d 1 Rp 750,000 Rp 750,000 Rp - Rp 750,000 - Rp - Rp - Rp 750,000 12
NIP. 19840904 201001 1 013

13 Rudianto - II/c 1 Rp 750,000 Rp 750,000 Rp - Rp 750,000 - Rp - Rp - Rp 750,000 13
NIP. 19670403 200801 1 001

14 S u m i a t y - II/b 1 Rp 750,000 Rp 750,000 Rp - Rp 750,000 - Rp - Rp - Rp 750,000 14
NIP. 19600620 198101 2 002
Medan, Maret 2017
Irma Yani, S.Sos

NIP. 19661103 198803 2 004
8
DAFTAR BUKTI PEMOTONGAN PAJAK PENGHASILAN PASAL 21
PADA PENERIMAAN TAMBAHAN PENGHASILAN BERDASARKAN BEBAN KERJA DAN PERTIMBANGAN OBJEKTIF
BULAN JUNI 2017
==========================================================================================
GOL. / JUMLAH OBJEK PPh 21

NO NPWP ALAMAT WP NAMA WAJIB PAJAK NIP
ESELON PPh 21 YANG DI POTONG
1 69.569.372.1-113.000 Jl. Prof. H.M. Yamin, SH No. 47 Medan Irma Yani, S.Sos 19661103 198803 2 004 III/d / IV.a Rp 3,300,000 Rp 165,000
2 77.249.107.2-113.000 Jl. Prof. H.M. Yamin, SH No. 47 Medan Dormini Situmorang, S.Psi 19660903 198503 2 001 III/d Rp 2,350,000 Rp 117,500
Jl. Maksum Pane Lk. I No. 00 Selat

3 77.249.107.2.113.000 Lancang Datuk Bandar Timur Kota Idhamsyah, S.Sos 19771002 199602 1 001 III/d Rp 2,350,000 Rp 117,500
Tanjung Balai
4 79.797.602.4-113.000 Jl. Prof. H.M. Yamin, SH No. 47 Medan Rohani Br. Sembiring 19670403 200801 2 001 III/d Rp 2,350,000 Rp 117,500
5 48.280.512.4-113.000 Jl. Prof. H.M. Yamin, SH No. 47 Medan Noliana, SE 19630109 199303 2 004 III/c Rp 2,350,000 Rp 117,500
6 48.280.452.3-113.000 Jl. Prof. H.M. Yamin, SH No. 47 Medan Arfah 19650416 199108 2 001 III/b Rp 2,350,000 Rp 117,500
Jl. Rakyat Pasar III Gg. Dahlia No. 8

7 67.665.317.3-113.000 Florida Pane, SE 19780709 200804 2 001 III/b Rp 2,350,000 Rp 117,500
Tegal Rejo, Medan Perjuangan
Meirtha Yolanda Stepu,
8 80.085.772.1-110.000 Jl. Prof. H.M. Yamin, SH No. 47 Medan 19850911 201101 2 019 III/b Rp 2,350,000 Rp 117,500
SKM.M.Kes
Jl. Flamboyan Raya No. 43 Tj. Selamat
9 36.463.271.1-121.000 Fransiska Isabella, SE 19830217 201001 2 028 III/a Rp 2,350,000 Rp 117,500
Medan
10 79.797.395.5-113.000 Jl. Prof. H.M. Yamin, SH No. 47 Medan Nurwuri Handayani, S.Sos 19800131 200801 2 006 III/a Rp 2,350,000 Rp 117,500
Jl. Imam Bonjol No. 155 Suka Jawa

11 08.499.247.8-322.001 Humaida 19631012 199203 2 004 III/a Rp 2,350,000 Rp 117,500
Tanjung Karang Barat Bandar Lampung
12 89.168.324.5-113.000 Jl. Prof. H.M. Yamin, SH No. 47 Medan Yani Sri Ningsih, SST 19830104 200701 2 001 III/a Rp 2,350,000 Rp 117,500
JUMLAH Rp 29,150,000 Rp 1,457,500
Medan, Juli 2017
NPWP : 00-430-579-3-124-000
Nama : Edi Suriono, SE
Bendahara Pengeluaran
Dinas Kesehatan Kota Medan
UNTUK BULAN MARET 2017
==================================================================================================
JUMLAH BRUTO
DITERIMA
TANDA TANGAN
5% 15% 20%
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Kasubbag
NIP. 19661103 198803 2 004 Kepegawaian
NIP. 19660903 198503 2 001
NIP. 19771002 199602 1 001
NIP. 19670403 200801 2 001
NIP. 19630109 199303 2 004
6 Rosmawati Banuarea 48.280.572.8-113.000 III/b 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 Rp - Rp - Rp 1,140,000 6
NIP. 19630725 198402 2 001

NIP. 19650416 199108 2 001
NIP. 19780709 200804 2 001
NIP. 19830217 201001 2 028

NIP. 19800131 200801 2 006

NIP. 19631012 199203 2 004
10
1 2 3 4 5 6 7 8 9 10 11 12 13 14
NIP. 19840904 201001 1 013

13 Maruli Juli Rutmarsaulina - II/d 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 - Rp - Rp - Rp 1,200,000 13
NIP. 19691210 199303 2 006

NIP. 19670403 200801 1 001
15 N g a p o n - II/c 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 - Rp - Rp - Rp 1,200,000 15
NIP. 19590512 198202 1 001

NIP. 19600620 198101 2 002
Medan, April 2017
Irma Yani, S.Sos

NIP. 19661103 198803 2 004
11
UNTUK BULAN MARET 2017
==================================================================================================
GOL/ JLH U. KESEJAHTERAAN JLH. UANG JUMLAH PPH. 21 JUMLAH UANG

5% 15% 20%
DITERIMA
1 2 3 4 5 6 7 8 9 10 11 12 13 14
NIP. 19661103 198803 2 004 IV.a
NIP. 19660903 198503 2 001
NIP. 19771002 199602 1 001
NIP. 19670403 200801 2 001

NIP. 19630109 199303 2 004
6 Rosmawati Banuarea 48.280.572.8-113.000 III/b 1 Rp 1,000,000 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 Rp - Rp - Rp 950,000 6
NIP. 19630725 198402 2 001
NIP. 19650416 199108 2 001
NIP. 19780709 200804 2 001

NIP. 19830217 201001 2 028

NIP. 19800131 200801 2 006

12
1 2 3 4 5 6 7 8 9 10 11 12 13 14
NIP. 19631012 199203 2 004
NIP. 19840904 201001 1 013

13 Maruli Juli Rutmarsaulina - II/d 1 Rp 750,000 Rp 750,000 Rp - Rp 750,000 - Rp - Rp - Rp 750,000 13
NIP. 19691210 199303 2 006

NIP. 19670403 200801 1 001

15 N g a p o n - II/c 1 Rp 750,000 Rp 750,000 Rp - Rp 750,000 - Rp - Rp - Rp 750,000 15
NIP. 19590512 198202 1 001

NIP. 19600620 198101 2 002
Medan, April 2017
Irma Yani, S.Sos

NIP. 19661103 198803 2 004
13
DAFTAR BUKTI PEMOTONGAN PAJAK PENGHASILAN PASAL 21
PADA PENERIMAAN TAMBAHAN PENGHASILAN BERDASARKAN BEBAN KERJA DAN PERTIM
BULAN JUNI 2017
===========================================================================
NO NPWP ALAMAT WP NAMA WAJIB PAJAK
1 69.569.372.1-113.000 Jl. Prof. H.M. Yamin, SH No. 47 Medan Irma Yani, S.Sos
2 77.249.107.2-113.000 Jl. Prof. H.M. Yamin, SH No. 47 Medan Dormini Situmorang, S.Psi
Jl. Maksum Pane Lk. I No. 00 Selat

3 77.249.107.2.113.000 Lancang Datuk Bandar Timur Kota Idhamsyah, S.Sos
Tanjung Balai
4 79.797.602.4-113.000 Jl. Prof. H.M. Yamin, SH No. 47 Medan Rohani Br. Sembiring
5 48.280.512.4-113.000 Jl. Prof. H.M. Yamin, SH No. 47 Medan Noliana, SE
6 48.280.452.3-113.000 Jl. Prof. H.M. Yamin, SH No. 47 Medan Arfah

Jl. Rakyat Pasar III Gg. Dahlia No. 8
7 67.665.317.3-113.000 Florida Pane, SE
Tegal Rejo, Medan Perjuangan
8 80.085.772.1-110.000 Jl. Prof. H.M. Yamin, SH No. 47 Medan
SKM.M.Kes
Jl. Flamboyan Raya No. 43 Tj. Selamat
9 36.463.271.1-121.000 Fransiska Isabella, SE
Medan
10 79.797.395.5-113.000 Jl. Prof. H.M. Yamin, SH No. 47 Medan Nurwuri Handayani, S.Sos
Jl. Imam Bonjol No. 155 Suka Jawa

11 08.499.247.8-322.001 Humaida
Tanjung Karang Barat Bandar Lampung
12 89.168.324.5-113.000 Jl. Prof. H.M. Yamin, SH No. 47 Medan Yani Sri Ningsih, SST
JUMLAH
PAJAK PENGHASILAN PASAL 21
SUD Dr. PIRNGADI KOTA MEDAN
SARKAN BEBAN KERJA DAN PERTIMBANGAN OBJEKTIF
UNI 2017
=============================================
GOL. / JUMLAH OBJEK PPh 21

NIP
ESELON PPh 21 YANG DI POTONG
19661103 198803 2 004 III/d / IV.a Rp 3,300,000 Rp 165,000
19660903 198503 2 001 III/d Rp 2,350,000 Rp 117,500
19771002 199602 1 001 III/d Rp 2,350,000 Rp 117,500
19670403 200801 2 001 III/d Rp 2,350,000 Rp 117,500
19630109 199303 2 004 III/c Rp 2,350,000 Rp 117,500
19650416 199108 2 001 III/b Rp 2,350,000 Rp 117,500
19780709 200804 2 001 III/b Rp 2,350,000 Rp 117,500
19850911 201101 2 019 III/b Rp 2,350,000 Rp 117,500
19830217 201001 2 028 III/a Rp 2,350,000 Rp 117,500
19800131 200801 2 006 III/a Rp 2,350,000 Rp 117,500
19631012 199203 2 004 III/a Rp 2,350,000 Rp 117,500
19830104 200701 2 001 III/a Rp 2,350,000 Rp 117,500
Rp 29,150,000 Rp 1,457,500
Medan, Juli 2017
NPWP : 00-430-579-3-124-000
Nama : Edi Suriono, SE
Bendahara Pengeluaran
Dinas Kesehatan Kota Medan
UNTUK BULAN APRIL 2017
==================================================================================================
JUMLAH BRUTO
DITERIMA
TANDA TANGAN
5% 15% 20%
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Kasubbag
NIP. 19661103 198803 2 004 Kepegawaian
NIP. 19660903 198503 2 001

NIP. 19771002 199602 1 001
NIP. 19670403 200801 2 001
NIP. 19630109 199303 2 004
NIP. 19650416 199108 2 001

NIP. 19780709 200804 2 001

Theodora Rosanti Elida Sagala,
8 34.527.333.8-124.000 III/b 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 Rp - Rp - Rp 1,140,000 8
SE.MM
NIP. 19860409 201001 2 026
NIP. 19830217 201001 2 028
NIP. 19800131 200801 2 006
16
1 2 3 4 5 6 7 8 9 10 11 12 13 14
NIP. 19631012 199203 2 004

NIP. 19840904 201001 1 013

13 Maslinda Sari Siregar - II/d 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 - Rp - Rp - Rp 1,200,000 13
NIP. 19790621 201101 2 003

NIP. 19670403 200801 1 001
NIP. 19590512 198202 1 001

NIP. 19600620 198101 2 002
17 Dedi Nofianto - II/a 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 - Rp - Rp - Rp 1,200,000 17
NIP. 19831110 200902 1 011
18 Marasi Tambunan - II/a 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 - Rp - Rp - Rp 1,200,000 18
NIP. 19671018 199103 1 002
Medan, Mei 2017
Irma Yani, S.Sos

NIP. 19661103 198803 2 004
17
UNTUK BULAN APRIL 2017
==================================================================================================

5% 15% 20%
DITERIMA
1 2 3 4 5 6 7 8 9 10 11 12 13 14
NIP. 19661103 198803 2 004 IV.a
NIP. 19660903 198503 2 001
NIP. 19771002 199602 1 001
NIP. 19670403 200801 2 001
NIP. 19630109 199303 2 004

NIP. 19650416 199108 2 001
NIP. 19780709 200804 2 001
Theodora Rosanti Elida Sagala,
8 34.527.333.8-124.000 III/b 1 Rp 1,000,000 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 Rp - Rp - Rp 950,000 8
SE.MM
NIP. 19860409 201001 2 026
NIP. 19830217 201001 2 028
NIP. 19800131 200801 2 006

18
1 2 3 4 5 6 7 8 9 10 11 12 13 14
NIP. 19631012 199203 2 004
NIP. 19840904 201001 1 013

13 Maslinda Sari Siregar - II/d 1 Rp 750,000 Rp 750,000 Rp - Rp 750,000 - Rp - Rp - Rp 750,000 13
NIP. 19790621 201101 2 003

NIP. 19670403 200801 1 001

NIP. 19590512 198202 1 001

NIP. 19600620 198101 2 002

17 Dedi Nofianto - II/a 1 Rp 750,000 Rp 750,000 Rp - Rp 750,000 - Rp - Rp - Rp 750,000 17
NIP. 19831110 200902 1 011

18 Marasi Tambunan - II/a 1 Rp 750,000 Rp 750,000 Rp - Rp 750,000 - Rp - Rp - Rp 750,000 18
NIP. 19671018 199103 1 002
Medan, Mei 2017
Irma Yani, S.Sos

NIP. 19661103 198803 2 004
19
UNTUK BULAN MEI 2017
==================================================================================================
JUMLAH BRUTO
DITERIMA
TANDA TANGAN
5% 15% 20%
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Kasubbag
NIP. 19661103 198803 2 004 Kepegawaian
NIP. 19660903 198503 2 001

NIP. 19771002 199602 1 001
NIP. 19670403 200801 2 001
NIP. 19630109 199303 2 004
NIP. 19650416 199108 2 001

NIP. 19780709 200804 2 001

SKM.M.Kes
NIP. 19850911 201101 2 019
NIP. 19830217 201001 2 028
NIP. 19800131 200801 2 006
Freddy Togap Manusun
11 35.160.008.5-127.000 III/a 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 Rp - Rp - Rp 1,140,000 11
Parlindungan, S.T.Ft
20
1 2 3 4 5 6 7 8 9 10 11 12 13 14
NIP. 19760613 201001 1 010
NIP. 19631012 199203 2 004
NIP. 19840904 201001 1 013

14 S u r i a n t o - II/c 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 - Rp - Rp - Rp 1,200,000 14
NIP. 19681227 200701 1 002

NIP. 19670403 200801 1 001

NIP. 19590512 198202 1 001
NIP. 19600620 198101 2 002

NIP. 19831110 200902 1 011
NIP. 19671018 199103 1 002
20 Hendi Wijaya - I/d 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 - Rp - Rp - Rp 1,200,000 20
NIP. 19790609 201001 1 021
Medan, Juni 2017
Irma Yani, S.Sos
21
1 2 3 4 5 6 7 8 9 10 11 12 13 14
NIP. 19661103 198803 2 004
22
==================================================================================================

PPH. 21 JUMLAH UANG
5% 15% 20%
DITERIMA
1 2 3 4 5 6 7 8 9 10 11 12 13 14
NIP. 19661103 198803 2 004 IV.a
NIP. 19660903 198503 2 001
NIP. 19771002 199602 1 001
NIP. 19670403 200801 2 001
NIP. 19630109 199303 2 004

NIP. 19650416 199108 2 001
NIP. 19780709 200804 2 001
SKM.M.Kes
NIP. 19850911 201101 2 019
NIP. 19830217 201001 2 028
NIP. 19800131 200801 2 006

Freddy Togap Manusun
11 35.160.008.5-127.000 III/a 1 Rp 1,000,000 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 Rp - Rp - Rp 950,000 11
Parlindungan, S.T.Ft
23
1 2 3 4 5 6 7 8 9 10 11 12 13 14
NIP. 19760613 201001 1 010
NIP. 19631012 199203 2 004

NIP. 19840904 201001 1 013

14 S u r i a n t o - II/c 1 Rp 750,000 Rp 750,000 Rp - Rp 750,000 - Rp - Rp - Rp 750,000 14
NIP. 19681227 200701 1 002

NIP. 19670403 200801 1 001

NIP. 19590512 198202 1 001

NIP. 19600620 198101 2 002

NIP. 19831110 200902 1 011

NIP. 19671018 199103 1 002

20 Hendi Wijaya - I/d 1 Rp 750,000 Rp 750,000 Rp - Rp 750,000 - Rp - Rp - Rp 750,000 20
NIP. 19790609 201001 1 021
Medan, Juni 2017
Irma Yani, S.Sos
24
1 2 3 4 5 6 7 8 9 10 11 12 13 14
NIP. 19661103 198803 2 004
25
UNTUK BULAN JUNI 2017
==================================================================================================
JUMLAH BRUTO
DITERIMA
TANDA TANGAN
5% 15% 20%
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Kasubbag
NIP. 19661103 198803 2 004 Kepegawaian
NIP. 19660903 198503 2 001

NIP. 19771002 199602 1 001
NIP. 19670403 200801 2 001
NIP. 19630109 199303 2 004
NIP. 19650416 199108 2 001

NIP. 19780709 200804 2 001

SKM.M.Kes
NIP. 19850911 201101 2 019
NIP. 19830217 201001 2 028
NIP. 19800131 200801 2 006
26
1 2 3 4 5 6 7 8 9 10 11 12 13 14
11 H u m a i d a 08.499.247.8-322.001 III/a 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 Rp - Rp - Rp 1,140,000 11
NIP. 19631012 199203 2 004

12 Yani Sri Ningsih, SST 89.168.324.5-113.000 III/a 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 Rp - Rp - Rp 1,140,000 12
NIP. 19830104 200701 2 001

NIP. 19840904 201001 1 013
NIP. 19670403 200801 1 001

NIP. 19600620 198101 2 002

NIP. 19831110 200902 1 011

NIP. 19671018 199103 1 002
18 Hendi Wijaya - I/d 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 - Rp - Rp - Rp 1,200,000 18
NIP. 19790609 201001 1 021
Medan, Juli 2017
Irma Yani, S.Sos
27
1 2 3 4 5 6 7 8 9 10 11 12 13 14
NIP. 19661103 198803 2 004
28
==================================================================================================

5% 15% 20%
DITERIMA
1 2 3 4 5 6 7 8 9 10 11 12 13 14
NIP. 19661103 198803 2 004 IV.a

NIP. 19660903 198503 2 001

NIP. 19771002 199602 1 001
NIP. 19670403 200801 2 001
NIP. 19630109 199303 2 004

NIP. 19650416 199108 2 001
NIP. 19780709 200804 2 001
SKM.M.Kes
NIP. 19850911 201101 2 019
NIP. 19830217 201001 2 028

NIP. 19800131 200801 2 006
29
1 2 3 4 5 6 7 8 9 10 11 12 13 14
11 H u m a i d a 08.499.247.8-322.001 III/a 1 Rp 1,000,000 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 Rp - Rp - Rp 950,000 11
NIP. 19631012 199203 2 004

12 Yani Sri Ningsih, SST 89.168.324.5-113.000 III/a 1 Rp 1,000,000 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 Rp - Rp - Rp 950,000 12
NIP. 19830104 200701 2 001
NIP. 19840904 201001 1 013

NIP. 19670403 200801 1 001

NIP. 19600620 198101 2 002

NIP. 19831110 200902 1 011

NIP. 19671018 199103 1 002

18 Hendi Wijaya - I/d 1 Rp 750,000 Rp 750,000 Rp - Rp 750,000 - Rp - Rp - Rp 750,000 18
NIP. 19790609 201001 1 021

Medan, Juli 2017
Irma Yani, S.Sos
30
1 2 3 4 5 6 7 8 9 10 11 12 13 14
NIP. 19661103 198803 2 004
31
STAF SUBBAG KEPEGAWAIAN (ORIENTASI) RSUD Dr. PIRNGADI KOTA MEDAN
==================================================================================================
JUMLAH BRUTO
DITERIMA
TANDA TANGAN
5% 15% 20%
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 Dr. Nova Lolika Stephani Silitonga 36.771.159.5-127.000 III/c 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 Rp - Rp - Rp 1,140,000 1
NIP. 19781111 200604 2 006

Medan, .................................... 2017
Irma Yani, S.Sos

NIP. 19661103 198803 2 004
==================================================================================================

PPH. 21 JUMLAH UANG
5% 15% 20%
DITERIMA
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 Dr. Nova Lolika Stephani Silitonga 36.771.159.5-127.000 III/c 1 Rp 1,000,000 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 Rp - Rp - Rp 950,000 1
NIP. 19781111 200604 2 006

JUMLAH Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 Rp - Rp - Rp 950,000
Medan, ........................... 2017
Irma Yani, S.Sos

NIP. 19661103 198803 2 004
==================================================================================================
JUMLAH BRUTO
DITERIMA
TANDA TANGAN
5% 15% 20%
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 Dr. Nova Lolika Stephani Silitonga 36.771.159.5-127.000 III/c 1 Rp 1,200,000 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 Rp - Rp - Rp 1,140,000 1
NIP. 19781111 200604 2 006

Medan, .......................... 2017
Irma Yani, S.Sos

NIP. 19661103 198803 2 004
==================================================================================================

PPH. 21 JUMLAH UANG
5% 15% 20%
DITERIMA
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 Dr. Nova Lolika Stephani Silitonga 36.771.159.5-127.000 III/c 1 Rp 1,000,000 Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 Rp - Rp - Rp 950,000 1
NIP. 19781111 200604 2 006

JUMLAH Rp 1,000,000 Rp - Rp 1,000,000 Rp 50,000 Rp - Rp - Rp 950,000
Medan, ......................... 2017
Irma Yani, S.Sos

NIP. 19661103 198803 2 004

Insentif 2017

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DAFTAR : NAMA - NAMA PNS RSUD Dr.

PIRNGADI KOTA MEDAN YANG MENERIMA

NIP. 19661103 198803 2 004 RSUD Dr. Pirngadi Kota Medan

NIP. 19660903 198503 2 001

NIP. 19771002 199602 1 001

NIP. 19670403 200801 2 001

NIP. 19630109 199303 2 004

6 Rosmawati Banuarea 48.280.572.8-113.000 III/b - Staf 1 Rp 1,200,000 Rp - Rp 1,200,000 Rp 60,000 - - Rp 1,140,000

NIP. 19630725 198402 2 001

NIP. 19650416 199108 2 001

NIP. 19780709 200804 2 001

NIP. 19830217 201001 2 028

NIP. 19800131 200801 2 006

11 H u m a i d a - II/d Staf 1 Rp 1,200,000 Rp - Rp 1,200,000 Rp - - - Rp 1,200,000

NIP, 19631012 199203 2 004

12 Rudianto - II/c - Staf 1 Rp 1,200,000 Rp - Rp 1,200,000 Rp - - - Rp 1,200,000

NIP. 19670403 200801 1 001

NIP. 19600620 198101 2 002

Bagi yang tidak mempunyai NPWP 20%

Diketahui : Medan, 2017

Bend. Pengeluaran Direktur Juru Bayar

Abdul Rahim Situmorang, SE Dr. H. Edwin Effendi, M.Sc Beslina Malau

JUMLAH JUMLAH BULAN JUMLAH

NIP. 19661103 198803 2 004 RSUD Dr. Pirngadi Kota Medan

NIP. 19660903 198503 2 001

NIP. 19771002 199602 1 001

NIP. 19670403 200801 2 001

NIP. 19630109 199303 2 004

NIP. 19630725 198402 2 001

NIP. 19650416 199108 2 001

8 Florida Pane, SE 67.665.317.3-113.000 III/b - Staf 0 Rp - Rp - Rp - Rp - - - Rp -

NIP. 19780709 200804 2 001

NIP. 19830217 201001 2 028

NIP. 19800131 200801 2 006

11 H u m a i d a - II/d Staf 1 Rp 750,000 Rp - Rp 750,000 - - - Rp 750,000

NIP, 19631012 199203 2 004

NIP. 19670403 200801 1 001

NIP. 19600620 198101 2 002

J U M LAH Rp 11,750,000 Rp - Rp 11,750,000 Rp 475,000 - - Rp 11,275,000

Diketahui : Medan, 2017

Bend. Pengeluaran Direktur Juru Bayar

Abdul Rahim Situmorang, SE Dr. H. Edwin Effendi, M.Sc Beslina Malau

NIP. 19840904 201001 1 013

Medan, Maret 2017

Irma Yani, S.Sos

GOL/ JLH U. KESEJAHTERAAN JLH. UANG JUMLAH

NIP. 19780709 200804 2 001

NIP. 19830217 201001 2 028

NIP. 19800131 200801 2 006

NIP. 19631012 199203 2 004

12 Firman Lubis, Amd - II/d 1 Rp 750,000 Rp 750,000 Rp - Rp 750,000 - Rp - Rp - Rp 750,000 12

NIP. 19840904 201001 1 013

NIP. 19670403 200801 1 001

Medan, Maret 2017

Irma Yani, S.Sos

GOL. / JUMLAH OBJEK PPh 21

Jl. Maksum Pane Lk. I No. 00 Selat

Jl. Rakyat Pasar III Gg. Dahlia No. 8

Jl. Imam Bonjol No. 155 Suka Jawa

JUMLAH Rp 29,150,000 Rp 1,457,500

Medan, Juli 2017

NIP. 19630725 198402 2 001

NIP. 19830217 201001 2 028

NIP. 19800131 200801 2 006