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20251007_DKHH_Laporan Bulanan Registrasi Pemegang Efek//Perubahan Struktur Pemegang Saham_31965430.pdf
Shareholder register Parsed DKHHSource file signed link, expires in 15 minutes
Extracted text 10
Page 1
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Nomor Surat 005/Lap.Corsec/CSM/X/2025
Nama Perusahaan PT Cipta Sarana Medika Tbk
Kode Emiten DKHH
Papan Pencatatan Pengembangan
Lampiran 1
Perihal Laporan Bulanan Registrasi Pemegang Efek
Perseroan menyampaikan Laporan Bulanan Registrasi Pemegang Efek yang berakhir pada 30 September 2025
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 Siliwangi Gading Bukit 2.019.998.000 79,22% 2.019.998.00 79,22%
Djajakusumah Indah, Jl. Raya 0 X
Gading Kirana
Blok J22, Klp.
Gading Bar.,
Kec. Klp.
Pemegang Gading, Jkt
Saham > 5% Utara, DKI
Jakarta 14240
Iqbal Rahim Jl. Teuku Umar Komisaris 2.000 0% 2.000 0%
Wilis No.61, X
RT.5/RW.5,
Menteng, Kec.
Menteng, Kota
Jakarta Pusat,
Daerah Khusus
Ibukota Jakarta
10310
0 0% 0 0%
Masyarakat - Warkat - Scrip
Page 2
530.000.000 20,78% 530.000.00 20,78%
Masyarakat - Non Warkat - Scripless 0
0 0% 0 0%
Saham Treasury
2.550.000.00 100% 2.550.000.00 100%
Total 0 0
Persentase Jumlah Saham (Bulan Persentase(Bulan
Nama Jumlah Saham (Sebelumnya)
(Sebelumnya) Ini) Ini)
2,020,000,000 79.22% 2,020,000,000 79.22%
Total Pengendali
530,000,000 20.78% 530,000,000 20.78%
Total Non Pengendali
Page 3
Informasi Saham Free Float
Keterangan Bulan Sebelumnya Bulan Ini
Jumlah saham scripless dimiliki oleh pemegang saham kurang
530.000.000 530.000.000
dari 5%
Jumlah saham scripless dimiliki oleh Direksi dan Dewan
0 0
Komisaris kurang dari 5%
Jumlah saham scripless dimiliki oleh Pengendali kurang dari 5% 0 0
Jumlah saham scripless dimiliki oleh Afiliasi dari Pengendali 0 0
kurang dari 5%
Jumlah treasury stock scripless kurang dari 5% 0 0
Jumlah saham portofolio investasi dengan penerima manfaat
0 0
investor publik yang telah disetujui Bursa untuk diperhitungkan
sebagai Free Float
Jumlah saham Free Float 530.000.000 530.000.000
Jumlah saham tercatat di Bursa per akhir bulan 2.550.000.000 2.550.000.000
% Saham Free Float 20,78 20,78
Jumlah Pemegang Saham
Bulan Sebelumnya Bulan Sekarang Perubahan
20.999 17.765 3.234
Penerima Manfaat Akhir dari Kepemilikan Saham
Page 4
Nomor Nama
1 Satria Muhammad Wilis
2 Perdana Aqila Wilis
3 Ryan M Wilis
4 Andri Kurniawan Wilis
5 Iqbal Rahim Wilis
6 Taruma Bambang T
7 Margiani Utami Bambang T
8 Yudistira Bambang T
Waran
Jumlah Waran Persen Waran Jumlah
Jumlah Waran Persen Waran
Nama Alamat Bulan Bulan Perubahan
Bulan Ini Bulan Ini
Sebelumnya Sebelumnya Waran
Masyarakat - 265.000.000 100% 265.000.000 100% 0
Demikian untuk diketahui.
Hormat Kami,
PT Cipta Sarana Medika Tbk
Page 5
Octen Suhadi
Direktur
PT Cipta Sarana Medika Tbk
Jl Siliwangi No. 139, Cibadak, Kec Cibadak, Kabupaten Sukabumi, Jawa Barat
Telepon : (021) 4586 9050, Fax : , www.dkhhospitals.com
Nama Pengirim Octen Suhadi
Jabatan Direktur
Tanggal dan Waktu 08-10-2025 11:34
Lampiran 1. DKHH 300925.pdf
Dokumen ini merupakan dokumen resmi PT Cipta Sarana Medika Tbk yang tidak memerlukan tanda tangan karena
dihasilkan secara elektronik oleh sistem pelaporan elektronik. PT Cipta Sarana Medika Tbk bertanggung jawab
penuh atas informasi yang tertera didalam dokumen ini.
Page 6
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Letter / Announcement No. 005/Lap.Corsec/CSM/X/2025
Issuer Name PT Cipta Sarana Medika Tbk
Issuer Code DKHH
Listing Board Development
Attachment 1
Subject Monthly Report of Securities Holders Registration
The Company hereby announce Monthly Report of Securities Holders Registration which ends in 30 September
2025 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 Siliwangi Gading Bukit 2,019,998,000 79.22% 2,019,998,00 79.22%
Djajakusumah Indah, Jl. Raya 0 X
Gading Kirana
Blok J22, Klp.
Gading Bar.,
Share Kec. Klp.
Ownership > Gading, Jkt
5% Utara, DKI
Jakarta 14240
Iqbal Rahim Jl. Teuku Umar Komisaris 2,000 0% 2,000 0%
Wilis No.61, X
RT.5/RW.5,
Menteng, Kec.
Menteng, Kota
Jakarta Pusat,
Daerah Khusus
Ibukota Jakarta
10310
0 0% 0 0%
Masyarakat - Warkat - Scrip
530.000.000 20,78% 530.000.00 20,78%
Masyarakat - Non Warkat - Scripless 0
Page 7
0 0% 0 0%
Saham Treasury
2.550.000.00 100% 2.550.000.00 100%
Total 0 0
Percentage Number of Shares (This Percentage (This
Name Number of Shares (Previously)
(Previous) Month) Month)
2,020,000,000 79.22% 2,020,000,000 79.22%
Total Controller
530,000,000 20.78% 530,000,000 20.78%
Total Non-Controllers
Page 8
Free Float Share Information
Information Previous Month This Month
The number of scripless shares owned by shareholders is less
530.000.000 530.000.000
than 5%
The number of scripless shares owned by the Board of Directors
0 0
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 0 0
Controller is less than 5%
The amount of scripless treasury stock is less than 5% 0 0
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 530.000.000 530.000.000
The number of shares listed on the Exchange at the end of the
2.550.000.000 2.550.000.000
month
% Free Float Share 20,78 20,78
Number of Shareholders
Previous Month This Month Change
20.999 17.765 3.234
Final Beneficiaries of Share Ownership
Page 9
Number Name
1 Satria Muhammad Wilis
2 Perdana Aqila Wilis
3 Ryan M Wilis
4 Andri Kurniawan Wilis
5 Iqbal Rahim Wilis
6 Taruma Bambang T
7 Margiani Utami Bambang T
8 Yudistira Bambang T
Warrants
Number of Percent of Number of Percent of Change in
Name Addresss Warrants Previous Warrants Warrants This Warrants This Number of
Month Previous Month Month Month Warrants
Masyarakat - 265,000,000 100% 265,000,000 100% 0
Thus to be informed accordingly.
Respectfully,
PT Cipta Sarana Medika Tbk
Page 10
Octen Suhadi
Direktur
PT Cipta Sarana Medika Tbk
Jl Siliwangi No. 139, Cibadak, Kec Cibadak, Kabupaten Sukabumi, Jawa Barat
Phone : (021) 4586 9050, Fax : , www.dkhhospitals.com
Sender Name Octen Suhadi
Function Direktur
Date and Time 08-10-2025 11:34
Attachment 1. DKHH 300925.pdf
This is an official document of PT Cipta Sarana Medika Tbk that does not require a signature as it was generated
electronically by the electronic reporting system. PT Cipta Sarana Medika Tbk is fully responsible for the
information contained within this document.
Names mentioned 14 people and organisations named in the text · linked when the evidence is strong
unresolved
org
PT. Adimitra Jasa Korpora
· Biro Administrasi Efek
p.1
unresolved
org
PT. Adimitra Jasa Korpora Persen
p.1
unresolved
org
PT Siliwangi Gading Bukit
p.1 ×2
unresolved
person
Satria Muhammad Wilis
p.4 ×2
unresolved
—
Perdana Aqila Wilis
p.4 ×2
unresolved
—
Ryan M Wilis
p.4 ×2
unresolved
—
Andri Kurniawan Wilis
p.4 ×2
unresolved
—
Taruma Bambang T
p.4 ×2
unresolved
—
Margiani Utami Bambang T
p.4 ×2
unresolved
—
Yudistira Bambang T
p.4 ×2
unresolved
person
Function
· Direktur
p.10
Extraction attempts how the parser did, and what it refused
Nothing structured was extracted from this document — the attempts below say why.
Rule parser
OK
confidence 0.900
224 ms
12 Sep 2026 22:34
Raw output
{'aggregates': {'total': {'pct': '100', 'shares': '2550000000'},
'treasury': {'pct': '0', 'shares': '0'},
'under5_non_warkat': {'pct': '20.78', 'shares': '530000000'},
'under5_warkat': {'pct': '0', 'shares': '0'}},
'as_of_date': '2025-09-30',
'checksum_ok': True,
'checksum_parts': '2550000000',
'holders': [{'address': 'Gading Bukit Indah, Jl. Raya Gading Kirana Blok J22, '
'Klp. Gading Bar.,',
'category': 'FIVE_PCT',
'is_controller': True,
'is_controller_affiliate': False,
'name': 'PT Siliwangi Djajakusumah',
'page_no': 1,
'pct': '79.22',
'pct_prev': '79.22',
'position': '',
'seq': 0,
'shares': '2019998000',
'shares_prev': '2019998000'},
{'address': 'Kec. Klp. Gading, Jkt Utara, DKI Jakarta 14240 Jl. '
'Teuku Umar No.61,',
'category': 'BOARD',
'is_controller': True,
'is_controller_affiliate': False,
'name': 'Iqbal Rahim Wilis',
'page_no': 1,
'pct': '0',
'pct_prev': '0',
'position': 'Komisaris',
'seq': 1,
'shares': '2000',
'shares_prev': '2000'}],
'issuer_name': 'PT Cipta Sarana Medika Tbk',
'issuer_ticker': 'DKHH',
'layout': 'EREP_COVER',
'letter_number': '005/Lap.Corsec/CSM/X/2025',
'listing_board': 'Pengembangan',
'period_label': 'September 2025',
'registrar': 'PT. Adimitra Jasa Korpora',
'total_shares': '2550000000'}