TY 2021 Form 990PF

- TIN:

Form990-PF
Click to see list of attachments

Department of the Treasury
Internal Revenue Service

Return of Private Foundation

or Section 4947(a)(1) Trust Treated as Private Foundation

Do not enter social security numbers on this form as it may be made public.
bullet

Go to www.irs.gov/Form990PF for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

For calendar year 2021, or tax year beginning 01-01-2021 , and ending 12-31-2021

Name of foundation
DBJ FOUNDATION

Number and street (or P.O. box number if mail is not delivered to street address)600 SUPERIOR AVENUE EAST 2430
Room/suite

City or town, state or province, country, and ZIP or foreign postal code
CLEVELAND, OH44114

A Employer identification number

34-1661482

B Telephone number (see instructions)

C If exemption application is pending, check here bullet

G Check all that apply: Initial returnInitial return of a former public charity
Final returnAmended return
Address change Name change

D 1. Foreign organizations, check here............. bullet

2. Foreign organizations meeting the 85%
test, check here and attach computation ... bullet

E If private foundation status was terminated
under section 507(b)(1)(A), check here ....... bullet

H Check type of organization: Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust Other taxable private foundation

F If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here ....... bullet

I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16) bullet

$25,247,685J Accounting method: Cash Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)

	Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)	(a) Revenue and expenses per books		(b) Net investment income	(d) Disbursements for charitable purposes (cash basis only)


1	Contributions, gifts, grants, etc., received (attach schedule)
2	Check .............
3	Interest on savings and temporary cash investments	79		79
4	Dividends and interest from securities...	357,744		357,744
5a	Gross rents............
b	Net rental income or (loss)
6a	Net gain or (loss) from sale of assets not on line 10		4,454,319
b	Gross sales price for all assets on line 6a 14,313,388
7	Capital gain net income (from Part IV, line 2)...			4,454,319
8	Net short-term capital gain.........
9	Income modifications...........
10a	Gross sales less returns and allowances
b	Less: Cost of goods sold....
c	Gross profit or (loss) (attach schedule).....
11	Other income (attach schedule).......		481
12	Total. Add lines 1 through 11........	4,812,623		4,812,142
13	Compensation of officers, directors, trustees, etc.
14	Other employee salaries and wages......
15	Pension plans, employee benefits.......
16a	Legal fees (attach schedule).........
b	Accounting fees (attach schedule).......		6,902	3,451	3,451
c	Other professional fees (attach schedule)....		127,629	72,629	55,000
17	Interest...............
18	Taxes (attach schedule) (see instructions)...		1,543	1,543
19	Depreciation (attach schedule) and depletion...
20	Occupancy..............
21	Travel, conferences, and meetings.......
22	Printing and publications..........
23	Other expenses (attach schedule).......
24	Total operating and administrative expenses.
	Add lines 13 through 23..........	136,074		77,623	58,451
25	Contributions, gifts, grants paid.......	1,470,000			1,470,000
26	Total expenses and disbursements. Add lines 24 and 25	1,606,074		77,623	1,528,451
27	Subtract line 26 from line 12:
a	Excess of revenue over expenses and disbursements	3,206,549
b	Net investment income (if negative, enter -0-)			4,734,519
c	Adjusted net income (if negative, enter -0-)...

For Paperwork Reduction Act Notice, see instructions.

Cat. No. 11289X Form 990-PF (2021)

Form 990-PF (2021)

Page 2

Part II		Balance Sheets	Beginning of year	End of year
Part II		Balance Sheets	(a) Book Value	(b) Book Value	(c) Fair Market Value
	1	Cash—non-interest-bearing.............	77,211	480,381	480,381
	2	Savings and temporary cash investments.........	642,635	257,140	257,140
	3	Accounts receivable
		Less: allowance for doubtful accounts
	4	Pledges receivable
		Less: allowance for doubtful accounts
	5	Grants receivable.................
	6	Receivables due from officers, directors, trustees, and other
		disqualified persons (attach schedule) (see instructions).....
	7	Other notes and loans receivable (attach schedule)
		Less: allowance for doubtful accounts
	8	Inventories for sale or use..............
	9	Prepaid expenses and deferred charges..........
	10a	Investments—U.S. and state government obligations (attach schedule)
	b	Investments—corporate stock (attach schedule).......	16,972,825	17,915,439	20,737,769
	c	Investments—corporate bonds (attach schedule).......	1,583,651	3,829,911	3,772,395
	11	Investments—land, buildings, and equipment: basis
		Less: accumulated depreciation (attach schedule)
	12	Investments—mortgage loans.............
	13	Investments—other (attach schedule)..........
	14	Land, buildings, and equipment: basis
		Less: accumulated depreciation (attach schedule)
	15	Other assets (describe )
	16	Total assets (to be completed by all filers—see the
		instructions. Also, see page 1, item I)	19,276,322	22,482,871	25,247,685
	17	Accounts payable and accrued expenses..........
	18	Grants payable.................
	19	Deferred revenue.................
	20	Loans from officers, directors, trustees, and other disqualified persons
	21	Mortgages and other notes payable (attach schedule)......
	22	Other liabilities (describe )
	23	Total liabilities (add lines 17 through 22).........		0
		Foundations that follow FASB ASC 958, check here
		and complete lines 24, 25, 29 and 30.
	24	Net assets without donor restrictions...........	19,276,322	22,482,871
	25	Net assets with donor restrictions............
		Foundations that do not follow FASB ASC 958, check here
		and complete lines 26 through 30.
	26	Capital stock, trust principal, or current funds........
	27	Paid-in or capital surplus, or land, bldg., and equipment fund
	28	Retained earnings, accumulated income, endowment, or other funds
	29	Total net assets or fund balances (see instructions).....	19,276,322	22,482,871
	30	Total liabilities and net assets/fund balances (see instructions).	19,276,322	22,482,871

Part III

Analysis of Changes in Net Assets or Fund Balances

Total net assets or fund balances at beginning of year—Part II, column (a), line 29 (must agree with end-of-year figure reported on prior year’s return) ...............

19,276,322

Enter amount from Part I, line 27a .....................

3,206,549

Other increases not included in line 2 (itemize) bullet

Add lines 1, 2, and 3 ..........................

22,482,871

Decreases not included in line 2 (itemize) bullet

Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .

22,482,871

Form 990-PF (2021)

Page 3

Part IV

Capital Gains and Losses for Tax on Investment Income

(a) List and describe the kind(s) of property sold (e.g., real estate, 2-story brick warehouse; or common stock, 200 shs. MLC Co.)		(b) How acquired P—Purchase D—Donation	(c) Date acquired (mo., day, yr.)	(d) Date sold (mo., day, yr.)
1 a	1993.303 CAPITAL INCOME BUILDER-A	P	2015-05-14	2021-01-04
b	1981.297 CAPITAL INCOME BUILDER-A	P	2015-05-14	2021-01-05
c	784.56 CAPITAL INCOME BUILDER-A	P	2015-05-14	2021-01-06
d	223 ACTIVISION BLIZZARD INC	P	2021-09-28	2021-12-17
e	4 ALPHABET INC COM CL A	P	2021-09-28	2021-12-08
	60513.309 AMERICAN CENTURY INVESTMENTS AVANTIS US SM CAP VALUE INST	P	2020-04-09	2021-09-28
	84 AMETEK INC	P	2021-09-28	2021-12-08
	109 AMPHENOL CORP	P	2021-09-28	2021-12-08
	54 ANALOG DEVICES INC	P	2021-09-28	2021-12-08
	23 ANSYS INC	P	2021-09-28	2021-12-08
	152 APPLE INC	P	2021-09-28	2021-12-08
	41 AVERY DENNISON CORP	P	2021-09-28	2021-12-08
	152 CANADIAN PACIFIC RAILWAY	P	2021-09-28	2021-12-22
	0.852 CANADIAN PACIFIC RAILWAY	P	2021-09-28	2021-12-23
	44 CARLISLE COS INC	P	2021-09-28	2021-12-08
	59 CELANESE CORP	P	2021-09-28	2021-12-08
	136 CERNER CORP	P	2021-09-28	2021-12-08
	205 CITIZENS FINL GROUP INC	P	2021-09-28	2021-12-08
	113 CLEAN HARBORS INC	P	2021-09-28	2021-12-08
	278 CONAGRA BRANDS INC	P	2021-09-28	2021-12-08
	57 COPART INC	P	2021-09-28	2021-12-08
	318 DELTA AIR LINES INC	P	2021-09-28	2021-12-08
	9297.218 DFA EMERGING MARKETS CORE EQUITY PORT	P	2015-01-01	2021-09-28
	47083.755 DFA INTL LARGE CAP GWTH	P	2015-01-01	2021-09-28
	7472.712 DFA INTL SMALL CAP GWTH	P	2015-01-01	2021-09-28
	8149.643 DFA INTL SMALL CAP VALUE PORTFOLIO	P	2015-01-01	2021-09-28
	51897.342 DFA INTL VALUE PORTFOLIO	P	2015-01-01	2021-09-28
	398.915 DFA U.S. LARGE CAP VALUE PORTFOLIO	P	2021-03-30	2021-04-08
	5925.832 DFA U.S. LARGE CAP VALUE PORTFOLIO	P	2015-01-01	2021-04-08
	4521.97799999999 DFA U.S. LARGE CAP VALUE PORTFOLIO	P	2021-01-01	2021-09-28
	32299.766 DFA U.S. LARGE CAP VALUE PORTFOLIO	P	2015-01-01	2021-09-28
	61915.872 DFA U.S. LARGE CAP VALUE PORTFOLIO	P	2015-01-01	2021-09-28
	48 DOVER CORP	P	2021-09-28	2021-12-08
	112 HCA HEALTHCARE INC	P	2021-09-28	2021-11-08
	152 INGERSOLL RAND INC	P	2021-09-28	2021-12-08
	308 ISHARES INC JP MRG EM CRP BD ETF	P	2021-01-07	2021-12-08
	758 ISHARES TRUST 0-5 YR TIPS ETF	P	2021-01-01	2021-03-18
	441 ISHARES TRUST 3 7 YR TREAS BD ETF	P	2020-10-27	2021-01-07
	1353 ISHARES TRUST 3 7 YR TREAS BD ETF	P	2020-10-27	2021-07-07
	278 ISHARES TRUST 3 7 YR TREAS BD ETF	P	2021-09-28	2021-12-08
	388 ISHARES TRUST BROAD USD HIGH ETF	P	2021-09-28	2021-12-08
	1436 ISHARES TRUST CMBS ETF	P	2021-01-01	2021-01-07
	297 ISHARES TRUST CMBS ETF	P	2021-07-07	2021-12-08
	1186 ISHARES TRUST ISHS 1-5YR INVS ETF	P	2021-01-07	2021-12-08
	284 ISHARES TRUST MBS ETF	P	2020-10-27	2021-01-07
	335 ISHARES TRUST MBS ETF	P	2021-07-07	2021-12-08
	53 KANSAS CITY SOUTHERN	P	2021-09-28	2021-12-14
	0.8 KYNDRYL HLDGS INC COM	P	2021-09-28	2021-11-09
	145 MAXIMUS INC COM	P	2021-09-28	2021-12-08
	98 MCCORMICK & COMPANY INC	P	2021-09-28	2021-12-08
	52 MICROSOFT CORP	P	2021-09-28	2021-12-08
	60 NIKE INC COM CL B	P	2021-09-28	2021-12-08
	16681 NORTHERN LIGHTS WOA ALL ASSET I	P	2015-01-01	2021-09-28
	5283 NORTHERN LIGHTS WOA ALL ASSET I	P	2019-06-09	2021-12-08
	375 NVENT ELECTRIC PLC	P	2021-09-28	2021-12-08
	134 OMNICOM GROUP INC	P	2021-09-28	2021-12-08
	103 OWENS CORNING	P	2021-09-28	2021-12-08
	283 PRINCIPAL FINANCIAL CORP	P	2021-09-28	2021-12-08
	443 REGIONS FINANCIAL CORP	P	2021-09-28	2021-12-08
	89 SMUCKER (JM) CO	P	2021-09-28	2021-12-08
	158 STERICYCLE INC	P	2021-09-28	2021-12-08
	44 STERIS PLC	P	2021-09-28	2021-12-08
	509 STERLING BANCORP D	P	2021-09-28	2021-12-08
	47 TETRA TECH INC	P	2021-09-28	2021-12-08
	935 VALLEY NATIONAL BANCORP	P	2021-09-28	2021-12-08
	25275.114 VANGUARD GROWTH INDEX ADMIRAL	P	2015-01-01	2021-09-28
	6382.008 VANGUARD SMALL CAP GROWTH INDEX ADMIRAL	P	2015-01-01	2021-09-28
	38 VERISK ANALYTICS INC	P	2021-09-28	2021-12-08
	162 WINTRUST FINANCIAL CORP	P	2021-09-28	2021-12-08
	42 ZOETIS INC COM CL A	P	2021-09-28	2021-12-08
	Capital Gain Dividends

(e) Gross sales price		(g) Cost or other basis plus expense of sale	(h) Gain or (loss) (e) plus (f) minus (g)
a	125,000	122,301	2,699
b	125,000	121,565	3,435
c	50,000	48,138	1,862
d	13,683	17,022	-3,339
e	11,855	10,866	989
	933,720	415,738	517,982
	11,849	10,690	1,159
	9,106	8,245	861
	10,058	9,250	808
	9,306	7,903	1,403
	26,612	21,570	5,042
	8,836	8,713	123
	10,909	10,852	57
	61	61
	10,692	8,969	1,723
	9,429	9,048	381
	10,227	9,682	545
	9,758	9,707	51
	11,613	11,751	-138
	8,815	9,352	-537
	8,535	8,045	490
	12,364	13,814	-1,450
	234,838	188,615	46,223
	799,943	551,211	248,732
	146,007	104,041	41,966
	177,897	145,355	32,542
	1,005,761	879,596	126,165
	17,344	17,225	119
	257,646	228,470	29,176
	203,308	153,641	49,667
	1,452,194	1,091,491	360,703
	2,783,731	2,159,964	623,767
	8,249	7,624	625
	27,734	28,202	-468
	9,143	7,837	1,306
	15,714	16,302	-588
	80,039	78,617	1,422
	58,387	58,739	-352
	177,371	180,213	-2,842
	35,749	36,131	-382
	15,947	16,088	-141
	79,007	79,182	-175
	15,772	16,213	-441
	63,836	65,325	-1,489
	31,273	31,304	-31
	35,960	36,314	-354
	4,770	3,610	1,160
	16	23	-7
	11,485	12,116	-631
	8,688	8,159	529
	17,418	14,743	2,675
	10,215	8,718	1,497
	216,353	204,345	12,008
	70,830	64,139	6,691
	13,920	12,278	1,642
	9,377	9,904	-527
	9,792	9,091	701
	20,268	18,570	1,698
	10,029	9,560	469
	11,559	10,690	869
	9,289	10,864	-1,575
	10,146	9,263	883
	12,705	12,618	87
	8,872	6,943	1,929
	13,202	12,473	729
	3,803,131	1,942,946	1,860,185
	636,590	378,252	258,338
	8,704	7,666	1,038
	14,509	13,020	1,489
	9,644	8,096	1,548
			211,598

Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69			(l) Gains (Col. (h) gain minus col. (k), but not less than -0-) or Losses (from col.(h))
(i) F.M.V. as of 12/31/69	(j) Adjusted basis as of 12/31/69	(k) Excess of col. (i) over col. (j), if any
a			2,699
b			3,435
c			1,862
d			-3,339
e			989
			517,982
			1,159
			861
			808
			1,403
			5,042
			123
			57

			1,723
			381
			545
			51
			-138
			-537
			490
			-1,450
			46,223
			248,732
			41,966
			32,542
			126,165
			119
			29,176
			49,667
			360,703
			623,767
			625
			-468
			1,306
			-588
			1,422
			-352
			-2,842
			-382
			-141
			-175
			-441
			-1,489
			-31
			-354
			1,160
			-7
			-631
			529
			2,675
			1,497
			12,008
			6,691
			1,642
			-527
			701
			1,698
			469
			869
			-1,575
			883
			87
			1,929
			729
			1,860,185
			258,338
			1,038
			1,489
			1,548

2	Capital gain net income or (net capital loss)	If gain, also enter in Part I, line 7 If (loss), enter -0- in Part I, line 7	2	4,454,319
3	Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
	If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0- in Part I, line 8 ...................		3	70,247

Form 990-PF (2021)

Page 4

Part V

Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)

1a	Exempt operating foundations described in section 4940(d)(2), check here and enter “N/A" on line 1.
	Date of ruling or determination letter: (attach copy of letter if necessary–see instructions)
b	All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) of Part I, line 12, col. (b)
2	Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)	2
3	Add lines 1 and 2...........................	3	65,810
4	Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)	4
5	Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- .....	5	65,810
6	Credits/Payments:

a	2021 estimated tax payments and 2020 overpayment credited to 2021	6a	16,884
b	Exempt foreign organizations—tax withheld at source......	6b
c	Tax paid with application for extension of time to file (Form 8868)...	6c	60,000
d	Backup withholding erroneously withheld ...........	6d

7	Total credits and payments. Add lines 6a through 6d..............		7	76,884
8	Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached.		8
9	Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......		9
10	Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...		10	11,074
11	Enter the amount of line 10 to be: Credited to 2022 estimated tax11,074	Refunded	11

Part VI-A

Statements Regarding Activities

During the tax year, did the foundation attempt to influence any national, state, or local legislation or did

Yes

it participate or intervene in any political campaign? ....................

Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions

for the definition.................................

If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials

published or distributed by the foundation in connection with the activities.

Did the foundation file Form 1120-POL for this year?.....................

Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:

(1) On the foundation. bullet

$ (2) On foundation managers. bullet

Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed

on foundation managers. bullet

Has the foundation engaged in any activities that have not previously been reported to the IRS?.......

If "Yes," attach a detailed description of the activities.

Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles

of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....

Did the foundation have unrelated business gross income of $1,000 or more during the year?.........

If "Yes," has it filed a tax return on Form 990-T for this year?...................

Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........

If "Yes," attach the statement required by General Instruction T.

Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:

By language in the governing instrument, or

By state legislation that effectively amends the governing instrument so that no mandatory directions

that conflict with the state law remain in the governing instrument?................

Yes

Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),

and Part XIV..................................

Yes

Enter the states to which the foundation reports or with which it is registered (see instructions)

If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney

General (or designate) of each state as required by General Instruction G? If "No," attach explanation .

Yes

Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)

or 4942(j)(5) for calendar year 2021 or the taxable year beginning in 2021? See the instructions for Part XIII.

If "Yes," complete Part XIII .............................

Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names

and addresses. ...............................

Form 990-PF (2021)

Page 5

Part VI-A

Statements Regarding Activities (continued)

At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the

meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions .............

Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had

advisory privileges? If "Yes," attach statement. See instructions.................

Did the foundation comply with the public inspection requirements for its annual returns and exemption application?

Yes

Website address bullet

DBJFOUNDATION.ORG

The books are in care of bullet

AVERY & GREIG LLP Telephone no. bullet

(310) 829-7654

Located at bullet

2811 WILSHIRE BLVD 700SANTA MONICACA ZIP+4 bullet

90403

Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here ......... bullet

and enter the amount of tax-exempt interest received or accrued during the year ........ bullet

16 At any time during calendar year 2021, did the foundation have an interest in or a signature or other authority over YesNo

a bank, securities, or other financial account in a foreign country? .................

16 No

See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country bullet

Part VI-B

Statements Regarding Activities for Which Form 4720 May Be Required

File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.

Yes

During the year did the foundation (either directly or indirectly):

(1) Engage in the sale or exchange, or leasing of property with a disqualified person? ...........

1a(1)

(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)

a disqualified person? ..............................

1a(2)

(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ...........

1a(3)

(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ............

1a(4)

(5) Transfer any income or assets to a disqualified person (or make any of either available

for the benefit or use of a disqualified person)? ......................

1a(5)

(6) Agree to pay money or property to a government official? (Exception. Check "No"

if the foundation agreed to make a grant to or to employ the official for a period

after termination of government service, if terminating within 90 days.) ...............

1a(6)

If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations

section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions ..........

Organizations relying on a current notice regarding disaster assistance check here........ bullet

Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,

that were not corrected before the first day of the tax year beginning in 2021? .............

Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private

operating foundation defined in section 4942(j)(3) or 4942(j)(5)):

At the end of tax year 2021, did the foundation have any undistributed income (lines 6d

and 6e, Part XII) for tax year(s) beginning before 2021?....................

If "Yes," list the years bullet

20, 20, 20, 20

Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)

(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)

to all years listed, answer "No" and attach statement—see instructions.) ..............

If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.

20, 20, 20, 20

Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at

any time during the year? ..............................

If "Yes," did it have excess business holdings in 2021 as a result of (1) any purchase by the foundation

or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved

by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)

the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine

if the foundation had excess business holdings in 2021.) .....................

Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?

Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its

charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2021? ..

Form 990-PF (2021)

Page 6

Part VI-B

Statements Regarding Activities for Which Form 4720 May Be Required (continued)

During the year did the foundation pay or incur any amount to:

Yes

(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ..........

5a(1)

(2) Influence the outcome of any specific public election (see section 4955); or to carry

on, directly or indirectly, any voter registration drive? ....................

5a(2)

(3) Provide a grant to an individual for travel, study, or other similar purposes? .............

5a(3)

(4) Provide a grant to an organization other than a charitable, etc., organization described

in section 4945(d)(4)(A)? See instructions ........................

5a(4)

(5) Provide for any purpose other than religious, charitable, scientific, literary, or

educational purposes, or for the prevention of cruelty to children or animals? .............

5a(5)

If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in

Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions ........

Organizations relying on a current notice regarding disaster assistance check here ......... bullet

If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the

tax because it maintained expenditure responsibility for the grant? .................

If "Yes," attach the statement required by Regulations section 53.4945–5(d).

Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on

a personal benefit contract? .............................

Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....

If "Yes" to 6b, file Form 8870.

At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?

If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction? .....

Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or

excess parachute payment during the year? .........................

Part VII

Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors

1 List all officers, directors, trustees, foundation managers and their compensation. See instructions

(a) Name and address	(b) Title, and average hours per week devoted to position	(c) Compensation (If not paid, enter -0-)	(d) Contributions to employee benefit plans and deferred compensation	(e) Expense account, other allowances
DAVID H JACOBS JR	Trustee 10.00	0
235 ENTRADA DR SANTA MONICA,CA90402	Trustee 10.00	0

2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."


(a) Name and address of each employee paid more than $50,000	(b) Title, and average hours per week devoted to position	(c) Compensation	(d) Contributions to employee benefit plans and deferred compensation	(e) Expense account, other allowances
NONE









Total number of other employees paid over $50,000...................

Form 990-PF (2021)

Page 7

Part VII

Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors (continued)

3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a) Name and address of each person paid more than $50,000	(b) Type of service	(c) Compensation
NONE

Total number of others receiving over $50,000 for professional services............. bullet

Part VIII-A

Summary of Direct Charitable Activities

List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.	Expenses
1


2


3


4

Part VIII-B

Summary of Program-Related Investments (see instructions)

Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.	Amount
1


2


All other program-related investments. See instructions.
3

Total. Add lines 1 through 3......................... bullet

Form 990-PF (2021)

Page 8

Part IX

Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)

Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,

purposes:

Average monthly fair market value of securities...................

24,300,615

Average of monthly cash balances.......................

237,271

Fair market value of all other assets (see instructions)................

Total (add lines 1a, b, and c).........................

24,537,886

Reduction claimed for blockage or other factors reported on lines 1a and

1c (attach detailed explanation) .............

Acquisition indebtedness applicable to line 1 assets..................

Subtract line 2 from line 1d.........................

24,537,886

Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see

instructions) .............................

368,068

Net value of noncharitable-use assets. Subtract line 4 from line 3. .......

24,169,818

Minimum investment return. Enter 5% (0.05) of line 5................

1,208,491

Part X

Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here right arrow

and do not complete this part.)

Minimum investment return from Part IX, line 6..................

1,208,491

Tax on investment income for 2021 from Part V, line 5.......

65,810

Income tax for 2021. (This does not include the tax from Part V.) ...

Add lines 2a and 2b............................

65,810

Distributable amount before adjustments. Subtract line 2c from line 1............

1,142,681

Recoveries of amounts treated as qualifying distributions................

Add lines 3 and 4............................

1,142,681

Deduction from distributable amount (see instructions).................

Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XII, line 1 ...

1,142,681

Part XI

Qualifying Distributions (see instructions)

Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:

Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........

Program-related investments—total from Part VIII-B..................

Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,

purposes...............................

Amounts set aside for specific charitable projects that satisfy the:

Suitability test (prior IRS approval required)....................

Cash distribution test (attach the required schedule) .................

Qualifying distributions. Add lines 1a through 3b. Enter here and on Part XII, line 4.

Form 990-PF (2021)

Page 9

Part XII

Undistributed Income (see instructions)

		(a) Corpus	(d) 2021
1 Distributable amount for 2021 from Part X, line 7			1,142,681
2 Undistributed income, if any, as of the end of 2021:
a Enter amount for 2020 only.......
b Total for prior years:20, 20, 20
3 Excess distributions carryover, if any, to 2021:
a From 2016......	472,748
b From 2017......	149,262
c From 2018......	1,715
d From 2019......	433,207
e From 2020......
f Total of lines 3a through e ........		1,056,932
4Qualifying distributions for 2021 from Part
XI, line 4: $ 1,528,451
a Applied to 2020, but not more than line 2a
b Applied to undistributed income of prior years (Election required—see instructions).....
c Treated as distributions out of corpus (Election required—see instructions)........		0
d Applied to 2021 distributable amount.....			1,142,681
e Remaining amount distributed out of corpus		385,770
5 Excess distributions carryover applied to 2021.
(If an amount appears in column (d), the same amount must be shown in column (a).)
6Enter the net total of each column as indicated below:
a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5		1,442,702
b Prior years’ undistributed income. Subtract line 4b from line 2b ..........
c Enter the amount of prior years’ undistributed income for which a notice of deficiency has been issued, or on which the section 4942(a) tax has been previously assessed......
d Subtract line 6c from line 6b. Taxable amount —see instructions ...........
e Undistributed income for 2019. Subtract line 4a from line 2a. Taxable amount—see instructions .............
f Undistributed income for 2021. Subtract lines 4d and 5 from line 1. This amount must be distributed in 2022 ..........			0
7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(F) or 4942(g)(3) (Election may be required - see instructions) .......
8 Excess distributions carryover from 2016 not applied on line 5 or line 7 (see instructions) ...		472,748
9 Excess distributions carryover to 2022. Subtract lines 7 and 8 from line 6a ......		969,954
10 Analysis of line 9:
a Excess from 2017....	149,262
b Excess from 2018....	1,715
c Excess from 2019....	433,207
d Excess from 2020....
e Excess from 2021....	385,770

Form 990-PF (2021)

Page 10

Part XIII

Private Operating Foundations (see instructions and Part VI-A, question 9)

1a If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2021, enter the date of the ruling ....... bullet

b Check box to indicate whether the organization is a private operating foundation described in section 4942(j)(3) or4942(j)(5)

2a Enter the lesser of the adjusted net income from Part I or the minimum investment return from Part X for each year listed ..........	Tax year	Prior 3 years			(e) Total
	(a) 2021	(b) 2020	(c) 2019	(d) 2018	(e) Total

b 85% (0.85) of line 2a .........
c Qualifying distributions from Part XI, line 4 for each year listed .....
d Amounts included in line 2c not used directly for active conduct of exempt activities ..........
e Qualifying distributions made directly for active conduct of exempt activities. Subtract line 2d from line 2c ....
3 Complete 3a, b, or c for the alternative test relied upon:
a “Assets" alternative test—enter:
(1) Value of all assets ......
(2) Value of assets qualifying under section 4942(j)(3)(B)(i)
b “Endowment" alternative test— enter 2/3 of minimum investment return shown in Part IX, line 6 for each year listed ..
c “Support" alternative test—enter:
(1) Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalties) ....
(2) Support from general public and 5 or more exempt organizations as provided in section 4942(j)(3)(B)(iii)....
(3) Largest amount of support from an exempt organization
(4) Gross investment income

Part XIV

Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)

1Information Regarding Foundation Managers:

aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)

DAVID H JACOBS JR

bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.

2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:

Check here bullet

if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions

aThe name, address, and telephone number or e-mail address of the person to whom applications should be addressed:

DAVID H JACOBS JR
235 ENTRADA DR
SANTA MONICA,CA90402
(310) 573-1410

bThe form in which applications should be submitted and information and materials they should include:

A LETTER THAT INDICATES THE PURPOSE, THE INTENT, AND PROJECTED DATE.

cAny submission deadlines:

NONE

dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:

LIMITED TO RELIGIOUS, COMMUNITY, AND CHARITABLE PROGRAMS.

Form 990-PF (2021)

Page 11

Part XIV

Supplementary Information (continued)

3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient	If recipient is an individual, show any relationship to any foundation manager or substantial contributor	Foundation status of recipient	Purpose of grant or contribution	Amount
Name and address (home or business)		Foundation status of recipient	Purpose of grant or contribution	Amount
aPaid during the year
CITY MISSION 5310 CARNEGIE AVE CLEVELAND,OH44103			CONTRIBUTION TO TAX-EXEMPT ORG GENERAL FUND	10,000
CLEVELAND FOOD BANK 15500 SOUTH WATERLOO RD CLEVELAND,OH44110			CONTRIBUTION TO TAX-EXEMPT ORG GENERAL FUND	50,000
CLEVELAND SIGHT CENTER 1900 EAST 101ST ST PO BOX 1988 CLEVELAND,OH44106			CONTRIBUTION TO TAX-EXEMPT ORG GENERAL FUND	50,000
EITELJORG MUSEUM 500 W WASHINGTON ST INDIANAPOLIS,IN46204			CONTRIBUTION TO TAX-EXEMPT ORG GENERAL FUND	100,000
GLSEN 90 BROAD ST NEW YORK,NY10004			CONTRIBUTION TO TAX-EXEMPT ORG GENERAL FUND	250,000
INDIANA UNIVERSITY FOUNDATION PO BOX 500 BLOOMINGTON,IN47402			CONTRIBUTION TO TAX-EXEMPT ORG GENERAL FUND	25,000
THE POINT FOUNDATION 5757 WILSHIRE BLVD 307 LOS ANGELES,CA90036			CONTRIBUTION TO TAX-EXEMPT ORG GENERAL FUND	100,000
THE TREVOR PROJECT 9056 SANTA MONICA BLVD 100 WEST HOLLYWOOD,CA90069			CONTRIBUTION TO TAX-EXEMPT ORG GENERAL FUND	10,000
UNITED CEREBRAL PALSY OF GREATER CL 10011 EUCLID AVE CLEVELAND,OH44106			CONTRIBUTION TO TAX-EXEMPT ORG GENERAL FUND	20,000
VOCATIONAL GUIDANCE SERVICES 2239 EAST 55TH ST CLEVELAND,OH44103			CONTRIBUTION TO TAX-EXEMPT ORG GENERAL FUND	10,000
CORNUCOPIA INC 18120 SLOANE AVENUE LAKEWOOD,OH44107			CONTRIBUTION TO TAX-EXEMPT ORG GENERAL FUND	30,000
CLEVELAND RAPE CRISIS CENTER 526 SUPERIOR AVE STE 1400 CLEVELAND,OH44114			CONTRIBUTION TO TAX-EXEMPT ORG GENERAL FUND	150,000
ENVISION 2108 LAMBERTON ROAD CLEVELAND HEIGHTS,OH44118			CONTRIBUTION TO TAX-EXEMPT ORG GENERAL FUND	250,000
SANTA FE OPERA 301 Opera Drive Santa Fe,NM87506			CONTRIBUTION TO TAX-EXEMPT ORG GENERAL FUND	250,000
PROJECT ANGEL FOOD 922 Vine Street Los Angeles,CA90038			CONTRIBUTION TO TAX-EXEMPT ORG GENERAL FUND	10,000
PROJECT OPEN HAND 730 Polk Street San Francisco,CA94109			CONTRIBUTION TO TAX-EXEMPT ORG GENERAL FUND	10,000
THE GATHERING PLACE 2650 S John Williams Way E TULSA,OK74114			CONTRIBUTION TO TAX-EXEMPT ORG GENERAL FUND	10,000
OPEN DOORS ACADEMY 1427 East 36th Street Cleveland,OH44114			CONTRIBUTION TO TAX-EXEMPT ORG GENERAL FUND	10,000
BOYS HOPE GIRLS HOPE 101 W Argonne Drive 62 St Louis,MO63122			CONTRIBUTION TO TAX-EXEMPT ORG GENERAL FUND	20,000
THE NATURE CENTER AT SHAKER LAKES 2600 South Park Blvd Cleveland,OH44120			CONTRIBUTION TO TAX-EXEMPT ORG GENERAL FUND	105,000
Total ................................. 3a				1,470,000

bApproved for future payment

Total ................................. 3b

Form 990-PF (2021)

Page 12

Part XV-A

Analysis of Income-Producing Activities

Enter gross amounts unless otherwise indicated.	Unrelated business income		Excluded by section 512, 513, or 514		(e) Related or exempt function income (See instructions.)
1Program service revenue:	(a) Business code	(b) Amount	(c) Exclusion code	(d) Amount	(e) Related or exempt function income (See instructions.)
a
b
c
d
e
f
gFees and contracts from government agencies
2 Membership dues and assessments ....
3 Interest on savings and temporary cash investments ...........			14	79
4 Dividends and interest from securities ....
5 Net rental income or (loss) from real estate:
aDebt-financed property......
bNot debt-financed property.....
6 Net rental income or (loss) from personal property
7 Other investment income .....
8 Gain or (loss) from sales of assets other than inventory ............			18	4,454,319
9 Net income or (loss) from special events:
10 Gross profit or (loss) from sales of inventory
11 Other revenue: a
b
c
d
e
12 Subtotal. Add columns (b), (d), and (e) ..				4,812,623

13Total. Add line 12, columns (b), (d), and (e)..................

4,812,623

(See worksheet in line 13 instructions to verify calculations.)

Part XV-B

Relationship of Activities to the Accomplishment of Exempt Purposes

Line No.	Explain below how each activity for which income is reported in column (e) of Part XV-A contributed importantly to the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See instructions.)

Form 990-PF (2021)

Page 13

Part XVI

Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations

Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?

Yes

Transfers from the reporting foundation to a noncharitable exempt organization of:

(1) Cash...................................

1a(1)

(2) Other assets.................................

1a(2)

Other transactions:

(1) Sales of assets to a noncharitable exempt organization....................

1b(1)

(2) Purchases of assets from a noncharitable exempt organization..................

1b(2)

(3) Rental of facilities, equipment, or other assets.......................

1b(3)

(4) Reimbursement arrangements...........................

1b(4)

(5) Loans or loan guarantees.............................

1b(5)

(6) Performance of services or membership or fundraising solicitations................

1b(6)

Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............

If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.

(a) Line No.	(b) Amount involved	(c) Name of noncharitable exempt organization	(d) Description of transfers, transactions, and sharing arrangements

Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........Yes No

If "Yes," complete the following schedule.

(a) Name of organization	(b) Type of organization	(c) Description of relationship

Sign Here

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
				May the IRS discuss this return with the preparer shown below? See instructions. Yes No
	Signature of officer or trustee	Date	Title

Paid Preparer Use Only	Print/Type preparer's name	Preparer's Signature	Date	Check if self- employed	PTIN
	Firm's name				Firm's EIN
	Firm's address				Phone no.

Form 990-PF (2021)

Additional Data

Software ID:	21013475
Software Version:	2021v4.0

Form 990PF - Special Condition Description:

Special Condition Description

- TIN:

TY 2021 AccountingFeesSchedule

Name:

DBJ FOUNDATION

EIN:

34-1661482

Software ID:

21013475

Software Version:

2021v4.0

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
ACCOUNTING FEES	6,902	3,451	0	3,451

- TIN:

TY 2021 InvestmentsCorpBondsSchedule

Name:

DBJ FOUNDATION

EIN:

34-1661482

Software ID:

21013475

Software Version:

2021v4.0

Name of Bond	End of Year Book Value	End of Year Fair Market Value
AMERICAN FUNDS (SEE ATTACHED)	7,078	7,048
TD AMERITRADE INVESTMENTS (SEE ATTACHED)	3,822,833	3,765,347

- TIN:

TY 2021 InvestmentsCorpStockSchedule

Name:

DBJ FOUNDATION

EIN:

34-1661482

Software ID:

21013475

Software Version:

2021v4.0

Name of Stock	End of Year Book Value	End of Year Fair Market Value
AMERICAN FUNDS (SEE ATTACHED)	6,555,947	7,980,932
TD AMERITRADE INVESTMENTS (SEE ATTACHED)	11,359,492	12,756,837

- TIN:

TY 2021 OtherIncomeSchedule2

Name:

DBJ FOUNDATION

EIN:

34-1661482

Software ID:

21013475

Software Version:

2021v4.0

Description	Revenue And Expenses Per Books	Net Investment Income	Adjusted Net Income
Other Investment Income	481

- TIN:

TY 2021 OtherProfessionalFeesSchedule

Name:

DBJ FOUNDATION

EIN:

34-1661482

Software ID:

21013475

Software Version:

2021v4.0

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
ADVISOR FEES	72,629	72,629	0	0
TRAINING & COACHING	55,000	0	0	55,000

- TIN:

TY 2021 TaxesSchedule

Name:

DBJ FOUNDATION

EIN:

34-1661482

Software ID:

21013475

Software Version:

2021v4.0

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
FOREIGN	1,543	1,543