2022-05-12T18:10:42-05:00 2021-12-31 370267575 FAIRFIELD NATIONAL BANK 117 N E THIRD FAIRFIELD IL 62837 990PF 2021-01-01 136115138 PUCKETT FOUNDATION FAIRFIELD NATIONAL BANK TRUSTEE PUCK 6188422107 PO BOX 429 FAIRFIELD IL 62837 RICHARD MONTGOMERY TRUST OFFICER 6188422107 2022-05-11 1 RICHARD MONTGOMERY 999009999 BRADLEY D JESOP P00011568 6188422183 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z X 2355352 X X 59280 59280 143812 178095 143812 203092 203092 22824 6847 7988 1300 0 650 30 15 0 24154 6862 8638 94631 94631 118785 6862 103269 84307 196230 28282 37334 37334 121459 87176 961210 1070728 1180266 1356807 1 1 1 1220470 1304777 2355352 0 0 X 1220470 1304777 0 0 0 0 1220470 1304777 1220470 1304777 1220470 84307 0 1304777 0 1304777 PUBLICLY TRADED SECURITIES P 164545 34283 130262 130262 CAPITAL GAINS DIVIDENDS P 13550 13550 13550 143812 2728 0 2728 0 2728 6044 0 0 0 6044 0 3316 3316 0 0 0 0 0 0 0 0 0 0 0 1 1 IL 1 0 0 0 0 1 N/A FAIRFIELD NATIONAL BANK TRUST DEPT 6188422107 220 E MAIN ST FAIRFIELD IL 62837 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 FAIRFIELD NATIONAL BANK 220 E MAIN ST FAIRFIELD IL 62837 TRUSTEE 15.00 22824 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 NONE 0 NONE 0 0 2270900 39624 0 2310524 0 0 2310524 34658 2275866 113793 113793 2728 2728 111065 0 111065 0 111065 103269 0 103269 111065 94631 0 0 103269 94631 0 0 8638 0 0 0 0 0 0 0 0 102427 0 0 0 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. AMY CHEN 1 CAIL ROAD FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 1500 ANIMALS REQUESTING FRIENDS PO BOX 324 FAIRFIELD IL 62837 N/A PC SPAY AND NUETER PROGRAM 3500 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 3000 CHLOE J HODGES 1993 CO RD 925 N FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 3000 FAIRFIELD MEMORIAL HOSPITAL FOUNDATION 303 NW 11TH ST FAIRFIELD IL 62837 N/A PC SUPPORT OF CHARITABLE HOSPITAL'S EXPANSION PROJECT 15000 FAIRFIELD PARK DISTRICT PO BOX 467 FAIRFIELD IL 62837 N/A GOV OPERATIONS 8000 FAIRFIELD PUBLIC LIBRARY FOUNDATION 300 SE 2ND ST FAIRFIELD IL 62837 N/A SO I SUPPORT OF PUBLIC LIBRARY 2500 FRONTIER COMMUNITY COLLEGE FOUNDATION 2 FRONTIER DRIVE FAIRFIELD IL 62837 N/A SO III NFI SUPPORT OF COMMUNITY COLLEGE 11860 HAPPY DAY EXPRESS INC 1009 NW 7TH ST FAIRFIELD IL 62837 N/A PC OPERATIONS OF DAY CARE 3500 JASON WRIGHT 2103 IL HWY 15 E FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 1500 JENNIFER ODOM 207 AIRPORT ROAD FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 1500 JUNIOR ACHIEVEMENT OF SW INDIANA 431 E DIAMOND AVE EVANSVILLE IN 47711 N/A PC OPERATIONS 3500 MEGAN TAYLOR STEPHENS 1209 LIGO LANE FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 3000 MICHAEL LANE HARVEY 432 CO RD 1800 E FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 1271 MIDWEST FOOD BANK 2031 WAREHOUSE ROAD NORMAL IL 61761 N/A PC FOOD PANTRY 3500 NORTH WAYNE AMBULANCE SERVICE PO BOX 133 CISNE IL 62823 N/A PC OPERATIONS 4000 PHOEBE AUGUST 1936 COUNTY RD 690 N FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 1500 SAMUEL P BEACH 1204 SW 6TH ST FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 1500 WABASH AREA DEVELOPMENT INC 2004 W DELAWARE FAIRFIELD IL 62837 N/A PC FOOD PANTRY 2500 WAYNE COUNTY AMBULANCE SERVICE PO BOX 92 FAIRFIELD IL 62837 N/A PC OPERATIONS 4000 WAYNE COUNTY HUMANE SOCIETY 518 SE 4TH ST FAIRFIELD IL 62837 N/A PC OPERATIONS OF ANIMAL SHELTER 3500 WAYNE-WHITE ROUND UP KARE & SHARE DENNIS SCRANTON MEMORIAL CANCER FUND PO BOX 700 FAIRFIELD IL 62837 N/A PC CANCER PATIENT TRANSPORTATION 6500 WYATT GILBERT 989 CO RD 2050 E FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 3000 NOAH MCELRAVY 26 KINCAID DRIVE FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 1500 94631 AMY CHEN 1 CAIL ROAD FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 3000 BREAH J MORLAN 309 NW 2ND ST FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 4500 CHLOE J HODGES 1993 CO RD 925 N FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 1500 JASON WRIGHT 2103 IL HWY 15 E FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 9000 JACOB BRITT 412 SE 4TH ST FAIRFIELD IL 62823 NONE I EDUCATION SCHOLARSHIP 12000 MEGAN TAYLOR STEPHEN 1209 LIGO LANE FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 4500 MICHAEL LANE HARVEY 432 CO RD 1800 E FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 9229 PHOEBE AUGUST 1936 COUNTY RD 690 N FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 9000 RICHARD TYLER HOOPER 2017 IL HWY 15 FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 4500 SAMUEL P BEACH 1204 SW 6TH ST FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 3000 WYATT GILBERT 989 CO RD 2050 E FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 7500 NOAH MCELRAVY 26 KINCAID DRIVE FAIRFIELD IL 62837 NONE I EDUCATION SCHOLARSHIP 10500 78229 14 59280 18 143812 0 203092 0 203092 0 0 0 0 0 0 0 0 0 0 MCDOWELL, KENSHALO & JESOP, LLC - PREP OF FORM 990-PF 1300 0 650 ALLSTATE CORP 7096 108944 CISCO SYSTEMS, INC 13616 63370 NORFOLK SOUTHERN CORP 6646 190534 INTEL CORP 11486 25750 MCDONALDS CORP 4373 187649 ORACLE CORP 13710 87210 VERIZON 23670 108544 MORGAN STANLEY 4591 76565 CARRIER GLOBAL CORPORATION COM 513 43392 OTIS WORLDWIDE CORP COM 718 34828 RAYTHEON TECHNOLOGIES CORP 757 34424 AMERICAN FUNDS - CAP INC BUILD CL F2 AT COST 282279 323963 AMERICAN FUNDS - BALANCE CL F2 AT COST 216542 362994 LORD ABBETT SHORT DURATION CL C AT COST 162000 153795 PIMCO INCOME FUND INSTITUTIONAL CL AT COST 48783 49095 FRANKLIN US GOVT ADVISOR CLASS AT COST 278646 274880 VANGUARD SCOTTDALE FDSLT CORP BD AT COST 40998 38949 VANGUARD SCOTTSDALE FDS INT CORP AT COST 40987 39423 AMERICAN CAPITAL WORLD GR & INC AT COST 40000 39314 VANGUARD INDEX FUNDS S&P 500 ETF AT COST 40294 43657 VANGUARD SMALL CAP VIPERS AT COST 29737 30737 OIL ROYALTY 1 1 1 ILLINOIS CHARITY FUND - ANNUAL STATE FILING FEE 15 0 0 INVESTMENT FEES 13 13 0 FOREIGN TAX 2 2 0