Altruist's Adornment
This medal is distributed in Genuine quality on a monthly basis to members who have done a giveaway in the 'Random Acts of TF2' subreddit, chosen by the community.
There are 528 known instances of this item in Genuine quality (and counting up).
Source
Genuine Altruist's Adornment
Team Fortress 2 Level 1 Community Medal
A medal to recognize the generous gifters of the Random Acts of TF2 group
( Not Tradable or Marketable )