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20231206_MIKA_Laporan Bulanan Registrasi Pemegang Efek//Perubahan Struktur Pemegang Saham_31546254.pdf
Shareholder register Parsed MIKASource file signed link, expires in 15 minutes
Extracted text 9
Page 1
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Nomor Surat 01/MIKA-XII/2023
Nama Perusahaan PT Mitra Keluarga Karyasehat Tbk.
Kode Emiten MIKA
Papan Pencatatan Utama
Lampiran 1
Perihal Laporan Bulanan Registrasi Pemegang Efek
Perseroan menyampaikan Laporan Bulanan Registrasi Pemegang Efek yang berakhir pada 30 November 2023
Sebagai Berikut :
Biro Administrasi Efek: PT. Adimitra Jasa Korpora
Persen
Jumlah Persen
Jumlah Saham Saham
Nama Alamat Jabatan Saham Bulan Saham Bulan Pengendali Afiliasi
Sebelumnya Sebelumny
Ini Ini
a
PT Griyainsani Jl. Letjen. 8.864.884.200 62,23% 8.864.884.20 62,23%
Cakrasadaya Suprapto Kav 0 X
4Jakarta Pusat
10510
Ir. Rustiyan Jl. Raya Gading Direksi 181.661.700 1,28% 181.661.700 1,28%
Pemegang Oen, MBA Kirana Kav.2 X
Saham > 5% Jakarta Utara
14240
Jozef Jl. Letjen. Komisaris 978.000 0,01% 978.000 0,01%
Darmawan Suprapto Kav X
4Jakarta Pusat
10510
Nurvantina Jl. Raya Gading Direksi 900 0% 900 0%
Pandina Kirana Kav.2
Jakarta Utara
14240
0 0% 0 0%
Masyarakat - Warkat - Scrip
4.859.956.70 34,1% 4.859.956. 34,1%
Masyarakat - Non Warkat - Scripless 0 700
Page 2
338.868.000 2,38% 338.868.000 2.38%
Saham Treasury
14.246.349.5 100% 14.246.349.5 100%
Total 00 00
Persentase Jumlah Saham (Bulan Persentase(Bulan
Nama Jumlah Saham (Sebelumnya)
(Sebelumnya) Ini) Ini)
8,864,884,200 62.23% 8,864,884,200 62.23%
Total Pengendali
5,381,465,300 37.77% 5,381,465,300 37.77%
Total Non Pengendali
Page 3
Informasi Saham Free Float
Keterangan Bulan Sebelumnya Bulan Ini
Jumlah saham scripless dimiliki oleh pemegang saham kurang
5.381.465.300 5.381.465.300
dari 5%
Jumlah saham scripless dimiliki oleh Direksi dan Dewan
182.640.600 182.640.600
Komisaris kurang dari 5%
Jumlah saham scripless dimiliki oleh Pengendali kurang dari 5% 0 0
Jumlah saham scripless dimiliki oleh Afiliasi dari Pengendali 2.476.111.000 2.476.111.000
kurang dari 5%
Jumlah treasury stock scripless kurang dari 5% 338.868.000 338.868.000
Jumlah saham portofolio investasi dengan penerima manfaat
0 0
investor publik yang telah disetujui Bursa untuk diperhitungkan
sebagai Free Float
Jumlah saham Free Float 2.383.845.700 2.383.845.700
Jumlah saham tercatat di Bursa per akhir bulan 14.246.349.500 14.246.349.500
% Saham Free Float 16,73 16,73
Jumlah Pemegang Saham
Bulan Sebelumnya Bulan Sekarang Perubahan
3.978 4.203 225
Penerima Manfaat Akhir dari Kepemilikan Saham
Page 4
Nomor Nama
1 Boenjamin Setiawan
2 Khouw Lip Swan
3 Gerda Veronica
4 Franciscus Bing Aryanto
5 Theresia Harsini
6 Maria Karmila
Demikian untuk diketahui.
Hormat Kami,
PT Mitra Keluarga Karyasehat Tbk.
Joyce V. Handajani
Corporate Secretary
PT Mitra Keluarga Karyasehat Tbk.
Jl. Raya Gading Kirana Kav.2 Jakarta Utara 14240
Telepon : (021) 4585 2700, Fax : (021) 4585 2727, http://www.mitrakeluarga.com/
Nama Pengirim Joyce V. Handajani
Jabatan Corporate Secretary
Tanggal dan Waktu 06-12-2023 14:44
Page 5
Lampiran 1. 11. MIKA - LAPORAN BULAN NOVEMBER 2023.pdf
Dokumen ini merupakan dokumen resmi PT Mitra Keluarga Karyasehat Tbk. yang tidak memerlukan tanda tangan
karena dihasilkan secara elektronik oleh sistem pelaporan elektronik. PT Mitra Keluarga Karyasehat Tbk.
bertanggung jawab penuh atas informasi yang tertera didalam dokumen ini.
Page 6
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Letter / Announcement No. 01/MIKA-XII/2023
Issuer Name PT Mitra Keluarga Karyasehat Tbk.
Issuer Code MIKA
Listing Board Main
Attachment 1
Subject Monthly Report of Securities Holders Registration
The Company hereby announce Monthly Report of Securities Holders Registration which ends in 30 November
2023 as follows:
Security Administration Bureau: PT. Adimitra Jasa Korpora
Number of Percent of Number of Percent of
Name Address Position Shares in Shares in Shares in Shares in Controller Affiliation
Previous Previous Current Current
PT Griyainsani Jl. Letjen. 8,864,884,200 62.23% 8,864,884,20 62.23%
Cakrasadaya Suprapto Kav 0 X
4Jakarta Pusat
10510
Share Ir. Rustiyan Jl. Raya Gading Direksi 181,661,700 1.28% 181,661,700 1.28%
Ownership > Oen, MBA Kirana Kav.2 X
5% Jakarta Utara
14240
Jozef Jl. Letjen. Komisaris 978,000 0.01% 978,000 0.01%
Darmawan Suprapto Kav X
4Jakarta Pusat
10510
Nurvantina Jl. Raya Gading Direksi 900 0% 900 0%
Pandina Kirana Kav.2
Jakarta Utara
14240
0 0% 0 0%
Masyarakat - Warkat - Scrip
4.859.956.70 34,1% 4.859.956. 34,1%
Masyarakat - Non Warkat - Scripless 0 700
338.868.000 2,38% 338.868.000 2.38%
Saham Treasury
Page 7
14.246.349.5 100% 14.246.349.5 100%
Total 00 00
Percentage Number of Shares (This Percentage (This
Name Number of Shares (Previously)
(Previous) Month) Month)
8,864,884,200 62.23% 8,864,884,200 62.23%
Total Controller
5,381,465,300 37.77% 5,381,465,300 37.77%
Total Non-Controllers
Free Float Share Information
Information Previous Month This Month
The number of scripless shares owned by shareholders is less
5.381.465.300 5.381.465.300
than 5%
The number of scripless shares owned by the Board of Directors
182.640.600 182.640.600
and Board of Commissioners is less than 5%
The number of scripless shares owned by the Controller is less
0 0
than 5%
The number of scripless shares owned by Affiliates of the 2.476.111.000 2.476.111.000
Controller is less than 5%
The amount of scripless treasury stock is less than 5% 338.868.000 338.868.000
Number of investment portfolio shares with public investor
0 0
beneficiaries that have been approved by the Exchange to be
counted as Free Float
The amount of Free Float Share 2.383.845.700 2.383.845.700
The number of shares listed on the Exchange at the end of the
14.246.349.500 14.246.349.500
month
% Free Float Share 16,73 16,73
Page 8
Number of Shareholders
Previous Month This Month Change
3.978 4.203 225
Final Beneficiaries of Share Ownership
Number Name
1 Boenjamin Setiawan
2 Khouw Lip Swan
3 Gerda Veronica
4 Franciscus Bing Aryanto
5 Theresia Harsini
6 Maria Karmila
Thus to be informed accordingly.
Respectfully,
PT Mitra Keluarga Karyasehat Tbk.
Joyce V. Handajani
Corporate Secretary
Page 9
PT Mitra Keluarga Karyasehat Tbk.
Jl. Raya Gading Kirana Kav.2 Jakarta Utara 14240
Phone : (021) 4585 2700, Fax : (021) 4585 2727, http://www.mitrakeluarga.com/
Sender Name Joyce V. Handajani
Function Corporate Secretary
Date and Time 06-12-2023 14:44
Attachment 1. 11. MIKA - LAPORAN BULAN NOVEMBER 2023.pdf
This is an official document of PT Mitra Keluarga Karyasehat Tbk. that does not require a signature as it was
generated electronically by the electronic reporting system. PT Mitra Keluarga Karyasehat Tbk. is fully responsible
for the information contained within this document.
Names mentioned 0 people and organisations named in the text · linked when the evidence is strong
The name pass has not read this document yet.
Extraction attempts how the parser did, and what it refused
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confidence 0.900
228 ms
12 Sep 2026 21:50
Raw output
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'treasury': {'pct': '2.38', 'shares': '338868000'},
'under5_non_warkat': {'pct': '34.1', 'shares': '4859956700'},
'under5_warkat': {'pct': '0', 'shares': '0'}},
'as_of_date': '2023-11-30',
'checksum_ok': True,
'checksum_parts': '14246349500',
'holders': [{'address': 'Jl. Letjen. Suprapto Kav 4Jakarta Pusat',
'category': 'FIVE_PCT',
'is_controller': True,
'is_controller_affiliate': False,
'name': 'Griyainsani Cakrasadaya',
'page_no': 1,
'pct': '62.23',
'pct_prev': '62.23',
'position': '',
'seq': 0,
'shares': '8864884200',
'shares_prev': '8864884200'},
{'address': '10510 Jl. Raya Gading Kirana Kav.2 Jakarta Utara',
'category': 'BOARD',
'is_controller': False,
'is_controller_affiliate': True,
'name': 'Rustiyan Oen, MBA',
'page_no': 1,
'pct': '1.28',
'pct_prev': '1.28',
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'seq': 1,
'shares': '181661700',
'shares_prev': '181661700'},
{'address': '14240 Jl. Letjen. Suprapto Kav 4Jakarta Pusat',
'category': 'BOARD',
'is_controller': False,
'is_controller_affiliate': True,
'name': 'Jozef Darmawan',
'page_no': 1,
'pct': '0.01',
'pct_prev': '0.01',
'position': 'Komisaris',
'seq': 2,
'shares': '978000',
'shares_prev': '978000'},
{'address': '10510 Jl. Raya Gading Kirana Kav.2',
'category': 'BOARD',
'is_controller': False,
'is_controller_affiliate': False,
'name': 'Nurvantina Pandina',
'page_no': 1,
'pct': '0',
'pct_prev': '0',
'position': 'Direksi',
'seq': 3,
'shares': '900',
'shares_prev': '900'}],
'issuer_name': 'PT Mitra Keluarga Karyasehat Tbk.',
'issuer_ticker': 'MIKA',
'layout': 'EREP_COVER',
'letter_number': '01/MIKA-XII/2023',
'listing_board': 'Utama',
'period_label': 'November 2023',
'registrar': 'PT. Adimitra Jasa Korpora',
'total_shares': '14246349500'}