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20260107_DKHH_Laporan Bulanan Registrasi Pemegang Efek//Perubahan Struktur Pemegang Saham_32017684_lamp1.pdf
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PEMEGANG SAHAM PENGENDALI
Bulan : Desember 2025
Emiten : PT Cipta Sarana Medika, Tbk.
No Nama & Alamat Pemegang Saham Jumlah Persentase
Saham Saham
1 Siliwangi Djajakusumah Hospitals, pT 2.019.998.000 79,27o/o
Gading Bukit Indah, Jl. Raya Gading Kirana BlokJZ2
Klp. Gading Barat Kec. Klp Gading
Jakarta Utara
Ledger : 000001
2. Iqbal Rahim Wilis
2.000 0,)ao/o
Jl. Teuku Umar No. 61, RT.5/RW.5
Menteng, Kec. Menteng
Jakafta Pusat
Ledger: 000002
LAPORAN KEPEMILIKAN SAHAM
OLEH DIREKSI DAN KOMISARIS
Bulan : Desember 2025
Emiten : PT Cipta Sarana Medika, Tbk.
No, Nama Jabatan Jumlah Persentase
Saham Saham
1 Iqbal Rahim Wilis Komisaris Utama 2.000 0,00%
2 Abdullah Sayidi Komisaris Independen 0 0,00o/o
3 Mohamad Luthfi Komisaris Independen 0 0,00%
4 Satria Muhammad Wilis Direktur Utama 0 0,00%
5 Octen Suhadi Direktur 0 0,00o/o
t,
Jakarta, 31 Desember 2025
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Direktur
Page 5
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FORMULIR NOMOR : X.H.1-1 LAMPIRAN 1
Peraturan Nomor X.H"1
LAPORAN KEPEMILIKAN EFEK YANG IV1ENCAPAI 5 O/O ATAU LEBIH
DARI SAHAM YANG DITEMPATKAN DAN DISETOR PENUH
Emiten PT CIPTA SARANA MEDIKA, TbK.
BAE PT ADIMITRA JASA KORPORA
Tanggal 31 Desember 2025
No Nama Pemegang Saham Status Jumlah Persentase
Alamat Pemegang Saham
Alr Saham Saham
1 Siliwanqi Diaiakusumah Hospitals, PT Gading Bukit Indah, Jl. Raya Gading Kirana Blok J22 I 2.019^998.000 79,2Lo/o
Klp. Gading Barat Kec. Klp Gading
Jakarta Utara
Ledger: 000001
J u m la h >> 2.019.998.000 79,21o/o
Catatan : Gabungan DPS dlm bentuk WARKAT & C-Best (Scrlpless)
Jakarta, 31 Desember 2025
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PT ADIMITRA JASA KORPORA
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