PUCKETT FOUNDATION: Form 990PF, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- PUCKETT FOUNDATION (EIN 13-6115138)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-05-12
- IRS object ID
- 202201329349104700
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990-PF
- Accounting Fees Schedule
- Investments Corp Stock Schedule
- Investments Other Schedule2
- Other Assets Schedule
- Other Expenses Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-12T18:10:42-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 370267575 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRFIELD NATIONAL BANK | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 117 N E THIRD | AddressLine1Txt |
| City | FAIRFIELD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62837 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 136115138 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PUCKETT FOUNDATION | BusinessNameLine1Txt |
| Business Name Line2 | FAIRFIELD NATIONAL BANK TRUSTEE | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PUCK | BusinessNameControlTxt |
| Phone | 6188422107 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 429 | AddressLine1Txt |
| City | FAIRFIELD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62837 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RICHARD MONTGOMERY | PersonNm |
| Person Title | TRUST OFFICER | PersonTitleTxt |
| Phone | 6188422107 | PhoneNum |
| Signature | 2022-05-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | RICHARD | PersonFirstNm |
| Person Last | MONTGOMERY | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BRADLEY D JESOP | PreparerPersonNm |
| PTIN | P00011568 | PTIN |
| Phone | 6188422183 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $2,355,352 | FMVAssetsEOYAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Schedule B Not Required | Yes (X) | ScheduleBNotRequiredInd |
| Dividends Rev And Expnss | $59,280 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $59,280 | DividendsNetInvstIncmAmt |
| Net Gain Sale Ast Rev And Expnss | $143,812 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $178,095 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $143,812 | CapGainNetIncmNetInvstIncmAmt |
| Total Rev And Expnss | $203,092 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $203,092 | TotalNetInvstIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $22,824 | CompOfcrDirTrstRevAndExpnssAmt |
| Comp Ofcr Dir Trst Net Invst Incm | $6,847 | CompOfcrDirTrstNetInvstIncmAmt |
| Comp Ofcr Dir Trst Dsbrs Chrtbl | $7,988 | CompOfcrDirTrstDsbrsChrtblAmt |
| Accounting Fees Rev And Expnss | $1,300 | AccountingFeesRevAndExpnssAmt |
| Accounting Fees Net Invst Incm | $0 | AccountingFeesNetInvstIncmAmt |
| Accounting Fees Chrtbl Prps | $650 | AccountingFeesChrtblPrpsAmt |
| Other Expenses Rev And Expnss | $30 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $15 | OtherExpensesNetInvstIncmAmt |
| Other Expenses Dsbrs Chrtbl | $0 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $24,154 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $6,862 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $8,638 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $94,631 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $94,631 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $118,785 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $6,862 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Dsbrs Chrtbl | $103,269 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | $84,307 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $196,230 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sav And Temp Cash Invst BOY | $28,282 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $37,334 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $37,334 | SavAndTempCashInvstEOYFMVAmt |
| Corporate Stock BOY | $121,459 | CorporateStockBOYAmt |
| Corporate Stock EOY | $87,176 | CorporateStockEOYAmt |
| Corporate Stock EOYFMV | $961,210 | CorporateStockEOYFMVAmt |
| Other Investments BOY | $1,070,728 | OtherInvestmentsBOYAmt |
| Other Investments EOY | $1,180,266 | OtherInvestmentsEOYAmt |
| Other Investments EOYFMV | $1,356,807 | OtherInvestmentsEOYFMVAmt |
| Other Assets BOY | $1 | OtherAssetsBOYAmt |
| Other Assets EOY | $1 | OtherAssetsEOYAmt |
| Other Assets EOYFMV | $1 | OtherAssetsEOYFMVAmt |
| Total Assets BOY | $1,220,470 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,304,777 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $2,355,352 | TotalAssetsEOYFMVAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Org Does Not Follow FASB117 | Yes (X) | OrgDoesNotFollowFASB117Ind |
| Capital Stock BOY | $1,220,470 | CapitalStockBOYAmt |
| Capital Stock EOY | $1,304,777 | CapitalStockEOYAmt |
| Additional Paid In Capital BOY | $0 | AdditionalPaidInCapitalBOYAmt |
| Additional Paid In Capital EOY | $0 | AdditionalPaidInCapitalEOYAmt |
| Retained Earning BOY | $0 | RetainedEarningBOYAmt |
| Retained Earning EOY | $0 | RetainedEarningEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $1,220,470 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $1,304,777 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $1,220,470 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $1,304,777 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $1,220,470 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | $84,307 | ExcessRevenueOverExpensesAmt |
| Other Increases | $0 | OtherIncreasesAmt |
| Subtotal | $1,304,777 | SubtotalAmt |
| Other Decreases | $0 | OtherDecreasesAmt |
| Tot Net Ast Or Fund Balances EOY | $1,304,777 | TotNetAstOrFundBalancesEOYAmt |
Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail
Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (2 entries)
| PropertyPropertyDesc | How AcquiredHowAcquiredCd | Gross Sales PriceGrossSalesPriceAmt | Cost Or Other BasisCostOrOtherBasisAmt | Gain Or LossGainOrLossAmt | Gains Minus Excess Or LossesGainsMinusExcessOrLossesAmt |
|---|---|---|---|---|---|
| PUBLICLY TRADED SECURITIES | P | $164,545 | $34,283 | $130,262 | $130,262 |
| CAPITAL GAINS DIVIDENDS | P | $13,550 | $13,550 | $13,550 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | $143,812 | CapitalGainNetIncomeAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $2,728 | InvestmentIncomeExciseTaxAmt |
| Tax Under Section511 | $0 | TaxUnderSection511Amt |
| Subtotal | $2,728 | SubtotalAmt |
| Subtitle A Tax | $0 | SubtitleATaxAmt |
| Tax Based On Investment Income | $2,728 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $6,044 | EstimatedPlusOvpmtIncmTxAmt |
| Exempt Frgn Org Tax Wthld At Srce | $0 | ExemptFrgnOrgTaxWthldAtSrceAmt |
| Extsn Request Income Tax Paid | $0 | ExtsnRequestIncomeTaxPaidAmt |
| Backup Withholding Withheld | $0 | BackupWithholdingWithheldAmt |
| Total Payments And Credits | $6,044 | TotalPaymentsAndCreditsAmt |
| Es Penalty | $0 | EsPenaltyAmt |
| Overpayment | $3,316 | OverpaymentAmt |
| Applied To ES Tax | $3,316 | AppliedToESTaxAmt |
| Refund | $0 | RefundAmt |
Statements Regarding Acty StatementsRegardingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Acty | 0 | LegislativePoliticalActyInd |
| More Than100 Spent | 0 | MoreThan100SpentInd |
| Form1120 POL Filed | 0 | Form1120POLFiledInd |
| Section4955 Organization Tax | $0 | Section4955OrganizationTaxAmt |
| Section4955 Managers Tax | $0 | Section4955ManagersTaxAmt |
| Tax Reimbursed | $0 | TaxReimbursedAmt |
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRptInd |
| Changes To Articles Or Bylaws | 0 | ChangesToArticlesOrBylawsInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtcInd |
| Section508e Rqr Satisfied | Yes (1) | Section508eRqrSatisfiedInd |
| At Least5000 In Assets | Yes (1) | AtLeast5000InAssetsInd |
| Org Report Or Register State | IL | OrgReportOrRegisterStateCd |
| Form990 PF Filed With Atty Gen | Yes (1) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | 0 | PrivateOperatingFoundationInd |
| New Substantial Contributors | 0 | NewSubstantialContributorsInd |
| Own Controlled Entity | 0 | OwnControlledEntityInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (1) | ComplyWithPublicInspRqrInd |
| Website Address | N/A | WebsiteAddressTxt |
| Individual With Books | FAIRFIELD NATIONAL BANK TRUST DEPT | IndividualWithBooksNm |
| Phone | 6188422107 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 E MAIN ST | AddressLine1Txt |
| City | FAIRFIELD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62837 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Accounts Question | 0 | ForeignAccountsQuestionInd |
Statements Regarding Acty4720 StatementsRegardingActy4720Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exch Disqualified Prsn | 0 | SaleOrExchDisqualifiedPrsnInd |
| Brrw Or Lend Disqualified Prsn | 0 | BrrwOrLendDisqualifiedPrsnInd |
| Furn Goods Disqualified Prsn | 0 | FurnGoodsDisqualifiedPrsnInd |
| Pay Comp Disqualified Prsn | 0 | PayCompDisqualifiedPrsnInd |
| Transfer Ast Disqualified Prsn | 0 | TransferAstDisqualifiedPrsnInd |
| Payment To Government Official | 0 | PaymentToGovernmentOfficialInd |
| Uncorrected Prior Acts | 0 | UncorrectedPriorActsInd |
| Undistributed Income PY | 0 | UndistributedIncomePYInd |
| Business Holdings | 0 | BusinessHoldingsInd |
| Jeopardy Investments | 0 | JeopardyInvestmentsInd |
| Uncorrected PY Jeopardy Invst | 0 | UncorrectedPYJeopardyInvstInd |
| Influence Legislation | 0 | InfluenceLegislationInd |
| Influence Election | 0 | InfluenceElectionInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Noncharitable Purpose | 0 | NoncharitablePurposeInd |
| Transactions Fail To Qlfy As Exc | 0 | TransactionsFailToQlfyAsExcInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt | Employee Benefit ProgramEmployeeBenefitProgramAmt | Expense Account Other AllwncExpenseAccountOtherAllwncAmt |
|---|---|---|---|---|---|---|---|---|
| FAIRFIELD NATIONAL BANK | ||||||||
| 220 E MAIN ST | FAIRFIELD | IL | 62837 | TRUSTEE | 15.00 | $22,824 | $0 | $0 |
| DIANE ROBINSON | ||||||||
| 220 E MAIN ST | FAIRFIELD | IL | 62837 | ADVISORY COMMITTEE | 1.00 | $0 | $0 | $0 |
| JUDITH PUCKETT | ||||||||
| 220 E MAIN ST | FAIRFIELD | IL | 62837 | ADVISORY COMMITTEE | 1.00 | $0 | $0 | $0 |
| DAVID HARRISON | ||||||||
| 220 E MAIN ST | FAIRFIELD | IL | 62837 | ADVISORY COMMITTEE | 1.00 | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Comp Of Hghst Pd Empl Or NONE | NONE | CompOfHghstPdEmplOrNONETxt |
| Other Employee Paid Over50k | 0 | OtherEmployeePaidOver50kCnt |
| Comp Of Hghst Pd Cntrct Or NONE | NONE | CompOfHghstPdCntrctOrNONETxt |
| Contractor Paid Over50k | 0 | ContractorPaidOver50kCnt |
Sum Of Program Related Invst SumOfProgramRelatedInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $2,270,900 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $39,624 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $2,310,524 | TotalFMVOfUnusedAssetsAmt |
| Reduction Claimed | $0 | ReductionClaimedAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $2,310,524 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $34,658 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $2,275,866 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $113,793 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $113,793 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $2,728 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $2,728 | TotalTaxAmt |
| Distributable Before Adj | $111,065 | DistributableBeforeAdjAmt |
| Recoveries Qualfied Distri | $0 | RecoveriesQualfiedDistriAmt |
| Distributable Before Ded | $111,065 | DistributableBeforeDedAmt |
| Deduction From Distributable | $0 | DeductionFromDistributableAmt |
| Distributable As Adjusted | $111,065 | DistributableAsAdjustedAmt |
PF Qualifying Distributions PFQualifyingDistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $103,269 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Qualifying Distributions | $103,269 | QualifyingDistributionsAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $111,065 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $94,631 | UndistributedIncomePYAmt |
| Total For Prior Years | $0 | TotalForPriorYearsAmt |
| Total Excess Distribution Cyov | $0 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $103,269 | QualifyingDistributionsAmt |
| Applied To Year1 | $94,631 | AppliedToYear1Amt |
| Applied To Prior Years | $0 | AppliedToPriorYearsAmt |
| Treated As Distri From Corpus | $0 | TreatedAsDistriFromCorpusAmt |
| Applied To Current Year | $8,638 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $0 | RemainingDistriFromCorpusAmt |
| Excess Distri Cyov App CY Corpus | $0 | ExcessDistriCyovAppCYCorpusAmt |
| Excess Distribution Cyov App CY | $0 | ExcessDistributionCyovAppCYAmt |
| Total Corpus | $0 | TotalCorpusAmt |
| Prior Year Undistributed Incm | $0 | PriorYearUndistributedIncmAmt |
| Prior Year Deficiency Or Tax | $0 | PriorYearDeficiencyOrTaxAmt |
| Taxable1 | $0 | Taxable1Amt |
| Taxable2 | $0 | Taxable2Amt |
| Undistributed Income CY | $102,427 | UndistributedIncomeCYAmt |
| Corpus Distri170b1 E Or4942g3 | $0 | CorpusDistri170b1EOr4942g3Amt |
| Excess Distri Cyov From Yr5 | $0 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $0 | ExcessDistriCyovToNextYrAmt |
Supplementary Information SupplementaryInformationGrp
Application Submission Info ApplicationSubmissionInfoGrp (2 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient PhoneRecipientPhoneNum | Recipient Email AddressRecipientEmailAddressTxt | Form And Info And MaterialsFormAndInfoAndMaterialsTxt | Submission DeadlinesSubmissionDeadlinesTxt | Restrictions On AwardsRestrictionsOnAwardsTxt |
|---|---|---|---|---|---|---|---|---|
| ANGIE KOONTZ - TRUST DEPARTMENT | ||||||||
| 220 E MAIN ST | FAIRFIELD | IL | 62837 | 6188422109 | TRUST@FNBCOMMUNITYBANK.COM | COMPLETED APPLICATION WITH VERIFICATION OF CHARITABLE/GOVERNMENTAL STATUS, DOCUMENTATION OF PROPOSED USE OF GRANT FUNDS AND NAME OF RESPONSIBLE PERSON. | NO SPECIFIC DEADLINE AS APPLICATIONS ARE REVIEWED ADVISORY COMMITTEE AS RECEIVED | NO LIMITATIONS ON GRANTS. ADVISORY COMMITTEE DETERMINES GRANTEES AND AMOUNTS. |
| ANGIE KOONTZ - TRUST DEPARTMENT | ||||||||
| 220 E MAIN ST | FAIRFIELD | IL | 62837 | 6188422109 | TRUST@FNBCOMMUNITYBANK.COM | APLICATION FORM AND DOCUMENTATION TO SUPPORT APPLICANT'S ELIGIBILITY AS TO CRITERIA OF MINIMUM ACT OF 19, 4.0 OR BETTER GPA AND CLASS RANK IN TOP 25%. | SCHOLARSHIP APPLICATIONS MUST BE SUBMITTED TO FCHS COUNSELING OFFICE BY MARCH 1 | APPLICANT MUST BE IN CURRENT GRADUATING CLASS OF FAIRFIELD COMMUNITY HIGH SCHOOL. ADVISORY COMMITTEE WILL DETERMINE NUMBER AND AMOUNT OF SCHOLARSHIPS. |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (25 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient RelationshipRecipientRelationshipTxt | Recipient Foundation StatusRecipientFoundationStatusTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt |
|---|---|---|---|---|---|---|---|
| AMY CHEN | |||||||
| 1 CAIL ROAD | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $1,500 |
| ANIMALS REQUESTING FRIENDS | |||||||
| PO BOX 324 | FAIRFIELD | IL | 62837 | N/A | PC | SPAY AND NUETER PROGRAM | $3,500 |
| CUMERLAND PRESBYTERIAN CHURCH | |||||||
| 1700 W DELAWARE ST | FAIRFIELD | IL | 62837 | NONE | PC | SECRET SANTA PROGRAM | $500 |
| BREAH J MORLAN | |||||||
| 309 NW 2ND ST | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $3,000 |
| CHLOE J HODGES | |||||||
| 1993 CO RD 925 N | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $3,000 |
| FAIRFIELD MEMORIAL HOSPITAL FOUNDATION | |||||||
| 303 NW 11TH ST | FAIRFIELD | IL | 62837 | N/A | PC | SUPPORT OF CHARITABLE HOSPITAL'S EXPANSION PROJECT | $15,000 |
| FAIRFIELD PARK DISTRICT | |||||||
| PO BOX 467 | FAIRFIELD | IL | 62837 | N/A | GOV | OPERATIONS | $8,000 |
| FAIRFIELD PUBLIC LIBRARY FOUNDATION | |||||||
| 300 SE 2ND ST | FAIRFIELD | IL | 62837 | N/A | SO I | SUPPORT OF PUBLIC LIBRARY | $2,500 |
| FRONTIER COMMUNITY COLLEGE FOUNDATION | |||||||
| 2 FRONTIER DRIVE | FAIRFIELD | IL | 62837 | N/A | SO III NFI | SUPPORT OF COMMUNITY COLLEGE | $11,860 |
| HAPPY DAY EXPRESS INC | |||||||
| 1009 NW 7TH ST | FAIRFIELD | IL | 62837 | N/A | PC | OPERATIONS OF DAY CARE | $3,500 |
| JASON WRIGHT | |||||||
| 2103 IL HWY 15 E | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $1,500 |
| JENNIFER ODOM | |||||||
| 207 AIRPORT ROAD | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $1,500 |
| JUNIOR ACHIEVEMENT OF SW INDIANA | |||||||
| 431 E DIAMOND AVE | EVANSVILLE | IN | 47711 | N/A | PC | OPERATIONS | $3,500 |
| MEGAN TAYLOR STEPHENS | |||||||
| 1209 LIGO LANE | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $3,000 |
| MICHAEL LANE HARVEY | |||||||
| 432 CO RD 1800 E | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $1,271 |
| MIDWEST FOOD BANK | |||||||
| 2031 WAREHOUSE ROAD | NORMAL | IL | 61761 | N/A | PC | FOOD PANTRY | $3,500 |
| NORTH WAYNE AMBULANCE SERVICE | |||||||
| PO BOX 133 | CISNE | IL | 62823 | N/A | PC | OPERATIONS | $4,000 |
| PHOEBE AUGUST | |||||||
| 1936 COUNTY RD 690 N | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $1,500 |
| SAMUEL P BEACH | |||||||
| 1204 SW 6TH ST | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $1,500 |
| WABASH AREA DEVELOPMENT INC | |||||||
| 2004 W DELAWARE | FAIRFIELD | IL | 62837 | N/A | PC | FOOD PANTRY | $2,500 |
| WAYNE COUNTY AMBULANCE SERVICE | |||||||
| PO BOX 92 | FAIRFIELD | IL | 62837 | N/A | PC | OPERATIONS | $4,000 |
| WAYNE COUNTY HUMANE SOCIETY | |||||||
| 518 SE 4TH ST | FAIRFIELD | IL | 62837 | N/A | PC | OPERATIONS OF ANIMAL SHELTER | $3,500 |
| WAYNE-WHITE ROUND UP KARE & SHARE DENNIS SCRANTON MEMORIAL CANCER FUND | |||||||
| PO BOX 700 | FAIRFIELD | IL | 62837 | N/A | PC | CANCER PATIENT TRANSPORTATION | $6,500 |
| WYATT GILBERT | |||||||
| 989 CO RD 2050 E | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $3,000 |
| NOAH MCELRAVY | |||||||
| 26 KINCAID DRIVE | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $1,500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $94,631 | TotalGrantOrContriPdDurYrAmt |
Grant Or Contri Apprv For Fut GrantOrContriApprvForFutGrp (12 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient RelationshipRecipientRelationshipTxt | Recipient Foundation StatusRecipientFoundationStatusTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt |
|---|---|---|---|---|---|---|---|
| AMY CHEN | |||||||
| 1 CAIL ROAD | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $3,000 |
| BREAH J MORLAN | |||||||
| 309 NW 2ND ST | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $4,500 |
| CHLOE J HODGES | |||||||
| 1993 CO RD 925 N | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $1,500 |
| JASON WRIGHT | |||||||
| 2103 IL HWY 15 E | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $9,000 |
| JACOB BRITT | |||||||
| 412 SE 4TH ST | FAIRFIELD | IL | 62823 | NONE | I | EDUCATION SCHOLARSHIP | $12,000 |
| MEGAN TAYLOR STEPHEN | |||||||
| 1209 LIGO LANE | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $4,500 |
| MICHAEL LANE HARVEY | |||||||
| 432 CO RD 1800 E | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $9,229 |
| PHOEBE AUGUST | |||||||
| 1936 COUNTY RD 690 N | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $9,000 |
| RICHARD TYLER HOOPER | |||||||
| 2017 IL HWY 15 | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $4,500 |
| SAMUEL P BEACH | |||||||
| 1204 SW 6TH ST | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $3,000 |
| WYATT GILBERT | |||||||
| 989 CO RD 2050 E | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $7,500 |
| NOAH MCELRAVY | |||||||
| 26 KINCAID DRIVE | FAIRFIELD | IL | 62837 | NONE | I | EDUCATION SCHOLARSHIP | $10,500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Apprv Fut | $78,229 | TotalGrantOrContriApprvFutAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
Dividends And Interest From Sec Dtl DividendsAndInterestFromSecDtl
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $59,280 | ExclusionAmt |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 18 | ExclusionCd |
| Exclusion | $143,812 | ExclusionAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Taxbl Incm | $0 | UnrelatedBusinessTaxblIncmAmt |
| Exclusion | $203,092 | ExclusionAmt |
| Related Or Exempt Function Incm | $0 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $203,092 | TotalIncomeProducingActyAmt |
Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Nonchrtbl EO | 0 | TrnsfrOfCashToNonchrtblEOInd |
| Trnsfr Other Asset Nonchrtbl EO | 0 | TrnsfrOtherAssetNonchrtblEOInd |
| Sales Or Exchanges Of Assets | 0 | SalesOrExchangesOfAssetsInd |
| Purchase Of Assets Nonchrtbl EO | 0 | PurchaseOfAssetsNonchrtblEOInd |
| Rental Of Facilities Oth Assets | 0 | RentalOfFacilitiesOthAssetsInd |
| Reimbursement Arrangements | 0 | ReimbursementArrangementsInd |
| Loans Or Loan Guarantees | 0 | LoansOrLoanGuaranteesInd |
| Performance Of Services Etc | 0 | PerformanceOfServicesEtcInd |
| Sharing Of Facilities Etc | 0 | SharingOfFacilitiesEtcInd |
| Relationships Nonchrtbl EO | 0 | RelationshipsNonchrtblEOInd |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees Detail AccountingFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | MCDOWELL, KENSHALO & JESOP, LLC - PREP OF FORM 990-PF | CategoryTxt |
| Amt | $1,300 | Amt |
| Net Investment Income | $0 | NetInvestmentIncomeAmt |
| Disbursements Charitable Prps | $650 | DisbursementsCharitablePrpsAmt |
Investments Corp Stock Schedule InvestmentsCorpStockSchedule
Investments Corporate Stock InvestmentsCorporateStockGrp (11 entries)
| StockStockNm | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| ALLSTATE CORP | $7,096 | $108,944 |
| CISCO SYSTEMS, INC | $13,616 | $63,370 |
| NORFOLK SOUTHERN CORP | $6,646 | $190,534 |
| INTEL CORP | $11,486 | $25,750 |
| MCDONALDS CORP | $4,373 | $187,649 |
| ORACLE CORP | $13,710 | $87,210 |
| VERIZON | $23,670 | $108,544 |
| MORGAN STANLEY | $4,591 | $76,565 |
| CARRIER GLOBAL CORPORATION COM | $513 | $43,392 |
| OTIS WORLDWIDE CORP COM | $718 | $34,828 |
| RAYTHEON TECHNOLOGIES CORP | $757 | $34,424 |
Investments Other Schedule2 InvestmentsOtherSchedule2
Investments Other InvestmentsOtherGrp (10 entries)
| Category Or ItemCategoryOrItemTxt | Listed At Cost Or FMVListedAtCostOrFMVCd | Book ValueBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|---|
| AMERICAN FUNDS - CAP INC BUILD CL F2 | AT COST | $282,279 | $323,963 |
| AMERICAN FUNDS - BALANCE CL F2 | AT COST | $216,542 | $362,994 |
| LORD ABBETT SHORT DURATION CL C | AT COST | $162,000 | $153,795 |
| PIMCO INCOME FUND INSTITUTIONAL CL | AT COST | $48,783 | $49,095 |
| FRANKLIN US GOVT ADVISOR CLASS | AT COST | $278,646 | $274,880 |
| VANGUARD SCOTTDALE FDSLT CORP BD | AT COST | $40,998 | $38,949 |
| VANGUARD SCOTTSDALE FDS INT CORP | AT COST | $40,987 | $39,423 |
| AMERICAN CAPITAL WORLD GR & INC | AT COST | $40,000 | $39,314 |
| VANGUARD INDEX FUNDS S&P 500 ETF | AT COST | $40,294 | $43,657 |
| VANGUARD SMALL CAP VIPERS | AT COST | $29,737 | $30,737 |
Other Assets Schedule OtherAssetsSchedule
Other Assets Schedule OtherAssetsScheduleGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OIL ROYALTY | Desc |
| BOY Book Value | $1 | BOYBookValueAmt |
| EOY Book Value | $1 | EOYBookValueAmt |
| EOYFMV | $1 | EOYFMVAmt |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (3 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| ILLINOIS CHARITY FUND - ANNUAL STATE FILING FEE | $15 | $0 | $0 |
| INVESTMENT FEES | $13 | $13 | $0 |
| FOREIGN TAX | $2 | $2 | $0 |