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20260907_DKHH_Laporan Bulanan Registrasi Pemegang Efek//Perubahan Struktur Pemegang Saham_32145484.pdf
Shareholder register Parsed DKHHSource file signed link, expires in 15 minutes
Extracted text 16
Page 1
Go To English Page Nomor Surat 018/Lap.Corsec/CSM/IX/2026 Nama Perusahaan PT Cipta Sarana Medika Tbk Kode Emiten DKHH Papan Pencatatan Pengembangan Lampiran 1 Perihal Laporan Bulanan Registrasi Pemegang Efek Bersama ini PT Cipta Sarana Medika Tbk menyatakan: 1. Bertanggung jawab atas penyusunan dan penyajian Laporan Bulanan Registrasi Pemegang Efek (LBRE). 2. Semua informasi dalam LBRE telah dimuat secara lengkap dan benar, tidak mengandung informasi atau fakta material yang tidak benar, dan tidak menghilangkan informasi atau fakta material. 3. Perhitungan Free Float telah disajikan sesuai dengan Peraturan Pencatatan Bursa Nomor I-A dan/atau I-V tentang Pencatatan Saham dan Efek Bersifat Ekuitas Selain Saham yang Diterbitkan oleh Perusahaan Tercatat, termasuk telah mengeluarkan kepemilikan saham oleh pihak Pengendali dan Afiliasi dari Pengendali, dan Afiliasi dari Pemilik Manfaat; dimiliki oleh anggota Dewan Komisaris atau anggota Direksi; dan saham yang telah dibeli kembali oleh perusahaan. Direksi atas nama PT Cipta Sarana Medika Tbk bertanggung jawab penuh atas informasi yang tertera didalam dokumen ini. Perseroan menyampaikan Laporan Bulanan Registrasi Pemegang Efek yang berakhir pada akhir bulan Agustus - 2026 Sebagai Berikut : Biro Administrasi Efek: PT. Adimitra Jasa Korpora
Page 2
Persen
Jumlah Persen
Jumlah Saham Saham Afiliasi
Nama Alamat Jabatan Saham Bulan Saham Bulan Pengendali
Sebelumnya Sebelumny Pengendali
Ini Ini
a
Pemegang Iqbal Rahim Jl. Teuku Umar Komisaris 2.000 0% 2.000 0%
Saham Wilis No.61,
Direksi dan RT.5/RW.5,
Menteng, Kec.
Komisaris
Menteng, Kota X
Jakarta Pusat,
Daerah Khusus
Ibukota Jakarta
10310
Persen
Jumlah Persen
Jumlah Saham Saham Afiliasi
Nama Alamat Saham Bulan Saham Bulan Pengendali
Sebelumnya Sebelumny Pengendali
Ini Ini
a
Pemegang PT Siliwangi Gading Bukit 2.019.998.000 79,21% 2.019.998.00 79,21%
saham 5% Djajakusumah Indah, Jl. Raya 0
(lima persen) Gading Kirana
Blok J22, Klp.
atau lebih
Gading Bar., X
Kec. Klp.
Gading, Jkt
Utara, DKI
Jakarta 14240
Pemegang Saham < 5%
0 0% 0 0%
Pemegang Saham < 5% - Warkat
530.312.624 20,79% 530.312.62 20,79%
Pemegang Saham < 5% - Non Warkat 4
0 0% 0 0%
Saham Treasuri
2.550.312.62 100% 2.550.312.62 100%
Total 4 4
Page 3
Jumlah Saham Scrip dan Scripless berdasarkan Tipe dan Klasifikasi Investor
Tipe dan Klasifikasi Investor Jumlah Saham
Afiliasi dari pengendali 0
Direksi dan Dewan Komisaris 2.000
Karyawan (hanya saham yang dibatasi pengalihan
0
kepemilikannya)
Pengendali 2.019.998.000
Saham Tresuri 0
Jumlah Saham Scripless berdasarkan Tipe dan Klasifikasi Investor dari KSEI
Tipe dan Klasifikasi Investor Jumlah Saham
Bank -
Government -
Private Equity -
Trustee Bank -
Venture Capital -
Private Bank -
Exchange Traded Funds -
Investment Manager -
Investment Advisors 1.713.500
Brokerage Firms -
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Hedge Fund - Sovereign Wealth Fund - Capital Market Supporting Institutions and Professions - Commanditaire Vennootschap (CV) or Limited partnership 500 Firm - Invesment Fund Selling Agent - Peer to peer lending - Permanent establishment - Sole proprietorship - Corporate 4.076.600 Association/social organization - State-owned enterprises - Central Bank - State Owned Company - Diocese - Conference - Congregation - Cooperatives - International organization - Political parties -
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Partnership - Educational Institution - Mutual Funds (MF) - Securities Company (SC) - Pension Funds (PF) - Financial Institutional (IB) - Insurance (IS) - Foundation (FD) 50 Individual (ID) 524.521.974 *Data klasifikasi investor yang disajikan dalam laporan ini bersumber dari informasi yang disampaikan oleh Pemegang Rekening KSEI berdasarkan hasil verifikasi yang dilakukan melalui proses Know Your Customer (KYC) atas data investor yang dikelolanya. Penetapanan klasifikasi investor dilakukan oleh masing-masing Pemegang Rekening KSEI dengan mengacu pada definisi dan panduan klasifikasi investor yang telah disediakan oleh KSEI. Keakuratan maupun kesesuaian pada penentuan klasifikasi investor yang tersaji dalam laporan ini menjadi tanggung jawab masing-masing Pemegang Rekening KSEI yang melakukan proses klasifikasi tersebut.
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Informasi Saham Free Float
Keterangan Bulan Sebelumnya Bulan Ini
Jumlah saham non-warkat dimiliki oleh seluruh pemegang
530.312.624 530.312.624
saham kurang dari 5%
Jumlah saham non-warkat dimiliki oleh Direksi dan Dewan
0 0
Komisaris kurang dari 5%
Jumlah saham non-warkat dimiliki oleh Pengendali kurang dari 5% 0 0
Jumlah saham non-warkat dimiliki oleh Afiliasi dari Pengendali 0 0
kurang dari 5%
Jumlah saham tresuri non-warkat kurang dari 5% 0 0
Jumlah saham yang harus dibatasi pengalihan kepemilikannya
0 0
(lock up) baik berdasarkan Peraturan maupun bagian tindakan
korporasi Perusahaan Tercatat kurang dari 5%
Jumlah saham non-warkat dimiliki oleh Perusahaan Modal 0 0
Ventura dan Private Equity kurang dari 5%
Jumlah saham non-warkat yang berada dalam status sita atau 0 0
blokir oleh Aparat Penegak Hukum atau Otoritas yang
berwenang kurang dari 5%
Jumlah saham dengan penerima manfaat investor publik yang 0 0
telah disetujui Bursa untuk diperhitungkan sebagai Free Float
(Ketentuan V.2 Peraturan I-A dan Ketentuan V.2 Peraturan I-V)
Jumlah saham Free Float 530.312.624 530.312.624
Jumlah saham tercatat di Bursa per akhir bulan 2.550.312.624 2.550.312.624
% Saham Free Float 20,79 20,79
Page 7
Persentase Bulan
Keterangan Bulan Sebelumnya Bulan Ini Persentase Bulan Ini
Sebelumnya
Jumlah saham tidak tercatat 0 0% 0 0%
Jumlah Pemegang Saham Nasabah Pemilik SID
Bulan Sebelumnya Bulan Sekarang Perubahan
16.520 16.004 516
Pemilik manfaat (pengendali tingkat individu) yang terdiri dari satu pihak atau kelompok yang terorganisasi dari PT Cipta Sarana Medika
Tbk
Pemegang Saham
Nama Pemegang % Kepemilikan
Nomor Nama Pemilik Manfaat Alamat Langsung
Saham Langsung Saham*
Perseroan
1 Satria Muhammad Wilis Jakarta, Indonesia Tidak PT Siliwangi 79 %
Djajakusumah
2 Perdana Aqila Wilis Jakarta, Indonesia Tidak PT Siliwangi 79 %
Djajakusumah
3 Ryan M Wilis Jakarta, Indonesia Tidak PT Siliwangi 79 %
Djajakusumah
4 Andri Kurniawan Wilis Jakarta, Indonesia Tidak PT Siliwangi 79 %
Djajakusumah
5 Iqbal Rahim Wilis Jakarta, Indonesia Ya 0%
6 Taruma Bambang T Jakarta, Indonesia Tidak PT Siliwangi 79 %
Djajakusumah
7 Margiani Utami Bambang T Jakarta, Indonesia Tidak PT Siliwangi 79 %
Djajakusumah
8 Yudistira Bambang T Jakarta, Indonesia Tidak PT Siliwangi 79 %
Djajakusumah
Page 8
* Persentase Kepemilikan, jika pemegang kolom pemegang saham langsung diisi:
- Ya : maka merupakan % kepemilikan pemilik manfaat langsung ke Perseroan
- Tidak : maka merupakan % kepemilikan pemengang saham langsung ke Perseroan
Demikian untuk diketahui.
Hormat Kami,
PT Cipta Sarana Medika Tbk
Satria Muhammad Wilis
Direktur utama
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 Satria Muhammad Wilis
Jabatan Direktur utama
Tanggal dan Waktu 08-09-2026 11:51
Lampiran 1. DKHH 310826.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.
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Go To Indonesian Page Letter / Announcement No. 018/Lap.Corsec/CSM/IX/2026 Issuer Name PT Cipta Sarana Medika Tbk Issuer Code DKHH Listing Board Development Attachment 1 Subject Monthly Report of Securities Holders Registration Hereby, the Company declares that: 1. It is responsible for the preparation and presentation of the Monthly Securities Holder Registration Report. 2. All information contained in the LBRE has been fully and accurately disclosed, does not contain any incorrect material information or facts, and does not omit any material information or facts. 3. The Free Float calculation has been presented in accordance with Listing Exchange Regulation Number I-A and/or I-V concerning the Listing of Shares and Equity Securities Other Than Shares Issued by Listed Companies, including the exclusion of share ownership by the Controlling Shareholder and its Affiliates; affiliates of beneficial owner; members of the Board of Commissioners or the Board of Directors; and treasury shares repurchased by the Company. The Board of Directors of PT Cipta Sarana Medika Tbk, on behalf of the Company, bears full responsibility for the information contained in this document. The Company hereby announce Monthly Report of Securities Holders Registration which ends in Agustus - 2026 Security Administration Bureau: PT. Adimitra Jasa Korpora
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Number of Percent of Number of Percent of Affiliate of
Name Address Position Shares in Shares in Shares in Shares in Controller the
Previous Previous Current Current Controller
Board of
Iqbal Rahim Jl. Teuku Umar Komisaris 2,000 0% 2,000 0%
Directors and Wilis No.61,
Board of RT.5/RW.5,
Commission Menteng, Kec.
ers Menteng, Kota X
Jakarta Pusat,
Daerah Khusus
Ibukota Jakarta
10310
Number of Percent of Number of Percent of Affiliate of
Name Address Shares in Shares in Shares in Shares in Controller the
Previous Previous Current Current Controller
PT Siliwangi Gading Bukit 2,019,998,000 79.21% 2,019,998,00 79.21%
Shareholders Djajakusumah Indah, Jl. 0
of 5% (five Raya Gading
percent) or Kirana Blok
more J22, Klp.
X
Gading Bar.,
Kec. Klp.
Gading, Jkt
Utara, DKI
Jakarta 14240
Share Ownership of <5%
0 0% 0 0%
Share Ownership of <5% - Scrip
530.312.624 20,79% 530.312.62 20,79%
Share Ownership of <5% - Scripless 4
0 0% 0 0%
Treasury Stock
2.550.312.62 100% 2.550.312.62 100%
Total 4 4
Page 11
Number of Scrip and Scripless Shares based on Investor Type and Classification Investor Type & Classification Number of Shares Affiliation from Controller 0 BOD / BOC 2.000 Employee (lock up shares only) 0 Controller 2.019.998.000 Treasury 0 Number of Scripless Shares based on Investor Type and Classification from KSEI Investor Type & Classification Number of Shares Bank - Government - Private Equity - Trustee Bank - Venture Capital - Private Bank - Exchange Traded Funds - Investment Manager - Investment Advisors 1.713.500 Brokerage Firms -
Page 12
Hedge Fund - Sovereign Wealth Fund - Capital Market Supporting Institutions and Professions - Commanditaire Vennootschap (CV) or Limited partnership 500 Firm - Investment Fund Selling Agent - Peer to peer lending - Permanent establishment - Sole proprietorship - Corporate 4.076.600 Association/social organizations - State Owned Enterprises - Central Bank - State Owned Company - Diocese - Conference - Congregation - Cooperatives - International organization - Political parties -
Page 13
Partnership - Educational Institution - Mutual Funds (MF) - Securities Company (SC) - Pension Funds (PF) - Financial Institutional (IB) - Insurance (IS) - Foundation (FD) 50 Individual (ID) 524.521.974 *The investor classification data presented in this report is derived from information provided by KSEI Account Holders based on verification conducted through the Know Your Customer (KYC) process on the investor data under their management. The determination of investor classification is carried out by each KSEI Account Holder with reference to the definitions and investor classification guidelines provided by KSEI. The accuracy and appropriateness of the investor classification presented in this report remain the responsibility of each KSEI Account Holder that performs the classification process.
Page 14
Free Float Share Information
Information Previous Month This Month
The number of scripless shares owned by shareholders is less
530.312.624 530.312.624
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
The number of shares owned less than 5% and subject to a lock-
up restriction, either based on regulations or the corporate 0 0
actions of the listed company.
The number of non-script shares owned less than 5% by venture 0 0
capital and private equity companies
The number of non-script shares owned less than 5% and 0 0
subject to confiscation or blocking by law enforcement officials or
authorized authorities.
Number of shares with public investor beneficiaries that have 0 0
been approved by IDX as Free Float (Provision V.2 of Regulation
I-A and Provision V.2 of Regulation I-V).
The amount of Free Float Share 530.312.624 530.312.624
The number of shares listed on the Exchange at the end of the
2.550.312.624 2.550.312.624
month
% Free Float Share 20,79 20,79
Page 15
Remarks Previous Month Previous Month Percentage Current Month Current Month Percentage
Number of Unlisted Shares 0 0% 0 0%
Number of Shareholders Holding SID Accounts
Previous Month Current Month Change
16.520 16.004 516
Beneficial owner (ultimate individual controller) consisting of one party or an organized group from PT Cipta
Sarana Medika Tbk
Company’s Direct Direct Shareholder % Share
Number Beneficial Owner Name Address
Shareholders Name Ownership*
1 Satria Muhammad Wilis Jakarta, Indonesia No PT Siliwangi 79 %
Djajakusumah
2 Perdana Aqila Wilis Jakarta, Indonesia No PT Siliwangi 79 %
Djajakusumah
3 Ryan M Wilis Jakarta, Indonesia No PT Siliwangi 79 %
Djajakusumah
4 Andri Kurniawan Wilis Jakarta, Indonesia No PT Siliwangi 79 %
Djajakusumah
5 Iqbal Rahim Wilis Jakarta, Indonesia Yes 0%
6 Taruma Bambang T Jakarta, Indonesia No PT Siliwangi 79 %
Djajakusumah
7 Margiani Utami Bambang T Jakarta, Indonesia No PT Siliwangi 79 %
Djajakusumah
8 Yudistira Bambang T Jakarta, Indonesia No PT Siliwangi 79 %
Djajakusumah
Page 16
*Ownership Percentage, if the “Direct Shareholder” column is filled:
- Yes: represents the % ownership of the beneficial owner directly in the Company
- No: represents the % ownership of the direct shareholder in the Company
Thus to be informed accordingly.
Respectfully,
PT Cipta Sarana Medika Tbk
Satria Muhammad Wilis
Direktur utama
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 Satria Muhammad Wilis
Function Direktur utama
Date and Time 08-09-2026 11:51
Attachment 1. DKHH 310826.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 8 people and organisations named in the text · linked when the evidence is strong
unresolved
org
PT. Adimitra Jasa Korpora
· Biro Administrasi Efek
p.1 ×2
unresolved
org
PT Siliwangi Gading Bukit
p.2 ×2
unresolved
org
PT Siliwangi
p.7 ×14
unresolved
org
Siliwangi | 79 %
Djajakusumah
p.7 ×14
unresolved
person
Satria Muhammad Wilis
· Direktur utama
p.8 ×2
unresolved
person
Function
· Direktur
p.16
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
242 ms
12 Sep 2026 21:36
Raw output
{'aggregates': {'total': {'pct': '100', 'shares': '2550312624'},
'treasury': {'pct': '0', 'shares': '0'},
'under5_non_warkat': {'pct': '20.79', 'shares': '530312624'},
'under5_warkat': {'pct': '0', 'shares': '0'}},
'as_of_date': '2026-08-31',
'checksum_ok': True,
'checksum_parts': '2550312624',
'holders': [{'address': 'Jl. Teuku Umar No.61,',
'category': 'BOARD',
'is_controller': True,
'is_controller_affiliate': False,
'name': 'Iqbal Rahim Wilis',
'page_no': 2,
'pct': '0',
'pct_prev': '0',
'position': 'Komisaris',
'seq': 0,
'shares': '2000',
'shares_prev': '2000'},
{'address': 'Gading Bukit Indah, Jl. Raya Gading Kirana Blok J22, '
'Klp. Gading Bar., Kec. Klp. Gading, Jkt Utara, DKI '
'Jakarta 14240',
'category': 'FIVE_PCT',
'is_controller': True,
'is_controller_affiliate': False,
'name': 'PT Siliwangi Djajakusumah',
'page_no': 2,
'pct': '79.21',
'pct_prev': '79.21',
'position': '',
'seq': 1,
'shares': '2019998000',
'shares_prev': '2019998000'}],
'issuer_name': 'PT Cipta Sarana Medika Tbk',
'issuer_ticker': 'DKHH',
'layout': 'EREP_COVER',
'letter_number': '018/Lap.Corsec/CSM/IX/2026',
'listing_board': 'Pengembangan',
'period_label': 'Agustus 2026',
'registrar': 'PT. Adimitra Jasa Korpora',
'total_shares': '2550312624'}