The Presidential Medal of Freedom is the highest civilian honor in the United States. Originally, Harry S. Truman established the “Medal of Freedom” to honor people who’d demonstrated notable service during World War II. In 1963, John F. Kennedy reintroduced it as the “Presidential Medal of Freedom,” which a commander-in-chief could bestow for many types of service and achievements. Since then, U.S. presidents have given to a wide range of over 500 people.

Truman established the Medal of Freedom on July 6, 1945, about two months after the Nazis surrendered and one month before the United States dropped nuclear bombs on Japan. Instead of a presidential honor, it was something that the secretaries of State, War or Navy could award anyone who had performed “a meritorious act or service” that aided the U.S. or one of its allies in war.

The first American citizen to receive the award was a female immigrant. Born in Budapest, Hungary in 1902, Anna Rosenberg immigrated to the Bronx borough of New York City with her family in 1912 and became an American citizen in 1919. She was a regional manager and regional director of the Social Security Board during its early years, and became the regional director of the War Manpower Commission in 1942. During the last year of World War II, she was a special envoy to Europe for Franklin D. Roosevelt and Truman.

It was future president General Dwight D. Eisenhower who recommended Rosenberg for the Medal of Freedom based on her service overseas. She received it from Secretary of War Robert P. Patterson on October 29, 1945.

Truman expanded the list of who could award the Medal of Freedom and why in 1952, but in February 1963, JFK reintroduced it as an honor specifically from the president. He also broadened the reasons that civilians could receive the award. Now, a person can receive it for “meritorious contribution to (1) the security or national interests of the United States, or (2) world peace, or (3) cultural or other significant public or private endeavors.”

JFK selected 31 individuals to receive the Presidential Medal of Freedom that year. They included Marian Anderson, an African American singer who sang at the Lincoln Memorial when Constitution Hall wouldn’t let her in; Genevieve Caulfield, a blind educator; Annie Dodge Wauneka, a member of the Navajo Nation Council; Ralph Bunche, the first black American to receive the Nobel Peace Prize; and Luis Muñoz Marín, the first elected governor of Puerto Rico.

However, JFK’s assassination in November meant that he was not alive to present the awards at the ceremony that December. His successor, Lyndon B. Johnson, presented them in his place. LBJ also posthumously awarded the award to JFK and Pope John XXIII.

During the five years and two months LBJ was president, he gave out 57 of his own Presidential Medals of Freedom. The next president to top that was Ronald Reagan, who gave out 86. Barack Obama holds the record for awarding 115 Presidential Medals of Freedom during his two terms. Two people have received the award twice: diplomat Ellsworth Bunker received the award from both JFK and LBJ, and General Colin Powell received the award from George H.W. Bush and Bill Clinton.

Most Presidential Medals of Freedom go to living people, but many don’t. Giving a posthumous award can be a way to celebrate those who didn’t receive recognition during their lifetimes, as when Obama gave the award to Rear Admiral Grace Hopper, a pioneer in computer programing. Other posthumous awards have gone to Martin Luther King, Jr., Cesar Chavez, Harvey Milk and Bayard Rustin.

Selections for the award often reflect a president’s own politics and ideals. George W. Bush presented the award to people who played prominent roles in the Iraq War, as well as Henry J. Hyde, author of the “Hyde Amendment” that banned public funding of abortion.

When Obama announced his first 16 honorees for the Presidential Medal of Freedom in 2009, the White House said he chose them “for their work as agents of change… They have blazed trails and broken down barriers.” These recipients included tennis player Billie Jean King, actress and singer Chita Rivera, comedian Ellen Degeneres and South African Archbishop Desmond Tutu. President Donald J. Trump gave awards to Edwin Meese III, a cabinet member under President Ronald Reagan known for his conservative policies, and Rush Limbaugh, a conservative radio icon, among others.