2017-11-15T15:38:42-06:00 2016-12-31 481195228 KELLER & OWENS LLC 10955 LOWELL AVE STE 800 OVERLAND PARK KS 66210 990 2016-01-01 473574130 IMPACT INVESTING CHARITABLE FOUNDATION INC IMPA 9132971804 6750 W 93RD STREET NO 100 OVERLAND PARK KS 66212 AIMEE MINNICH CIO 9132971804 2017-11-15 1 GREGORY D OWENS P00048643 9133383500 192.155.75.154 2017-11-15 10:03:39 CS P D15571A11307E8378394EB1E3A31CC0E03C15F86 5B2362C69821CA128AF4CC943447D1CAFC7C6289 2016 2021-01-29 14:40:06Z X AIMEE MINNICH 6750 W 93RD STREET NO 100 OVERLAND PARK KS 66212 22314504 0 X N/A X 2015 GA INVESTING CHARITABLE CAPITAL TO CREATE ECONOMIC, SOCIAL, AND SPRITUAL TRANSFORMATION 7 5 3 5 -12990 0 21643803 0 46481 470 21690754 2679083 0 343132 0 1450 434535 3456750 18234004 18530983 280740 18250243 INVESTING CHARIABLE CAPITAL TO CREATE ECONOMIC, SOCIAL, AND SPRITUAL TRANSFORMATION 0 0 3253417 2679083 THE ORGANIZATION FUNDS PROJECTS WITH A CHARITABLE PURPOSE OR A MISSION THAT ALIGNS WITH CHARITABLE CAUSES IN ADDITION TO PROVIDING A RETURN FOR FUTURE GRANTMAKING ACTIVITIES TO CHARITABLE ORGANIZATIONS. 3253417 1 1 0 0 0 1 0 0 0 0 0 1 1 0 0 1 0 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 1 1 15 0 3 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 5 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X THE ORGANIZATION 9132971804 6750 W 93RD STREET NO 100 OVERLAND PARK KS 66212 JEFFREY JOHNS CEO 40.00 X X 135000 0 0 AIMEE MINNICH CIO 40.00 X X 135000 0 0 CRAIG CHAPMAN DIRECTOR 0.50 X 0 0 0 APRIL CHAPMAN DIRECTOR 0.50 X 0 0 0 JONATHAN HARRISON TREASURER 0.50 X X 0 0 0 DAVID WILLS DIRECTOR 0.50 X 0 0 0 GREG LERNIHAN DIRECTOR 0.50 X 0 0 0 CHAD BATTISON DIRECTOR 0.50 X 0 0 0 270000 0 0 2 0 0 0 0 21643803 4937387 21643803 26655 -12990 39645 470 470 643576 623750 19826 19826 19826 21690754 0 -12990 59941 2679083 2679083 270000 207900 60750 1350 49500 24750 24750 23632 17208 6324 100 29391 29391 36175 36175 65995 65995 182521 139553 42968 35840 35840 10317 8792 1525 4345 4345 40603 40603 20775 20775 417 417 6583 6583 MISCELLANEOUS 1249 1249 PROFESSIONAL DUES/SUBSC 324 324 3456750 3253417 201883 1450 X 1635537 1265646 387016 5000 1275950 6973788 6988046 0 18530983 30740 250000 0 280740 X 18250243 0 18250243 0 18530983 X 18234004 31151 -14912 X 0 1 X 1 0 X 21643803 21643803 21643803 21643803 66322 21577481 40115 40115 21683918 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 45 18609887 302471 18210246 1 1 0 INVESTMENT IN SOVEREIGN CAPITAL 423788 F INVESTMENT IN SIMPLYWIN 600000 C INVESTMENT IN GLI 125000 C INVESTMENT IN SOLOMON'S FUND 75000 C INVESTMENT IN EAGLE LANDING 5000000 C INVESTMENT IN NEC AUSTIN 750000 C 6973788 INVESTMENT IN 1K1V 2499181 F INVESTMENT IN SERVINGLINK SOFTWARE STOCK 172969 F INVESTMENT IN CO-TRIBUTE 150000 C INVESTMENT IN LAOS AGRIVENTURES, LLC 166000 C INVESTMENT IN LANTERN GLOBAL PS 596973 C INVESTMENT IN PHOTO UP 400000 C INVESTMENT IN PATTERNS OF EVIDENCE 450000 C INVESTMENT IN IMAGINE FILM 875000 C INVESTMENT IN CORNELIUS FILM 200000 C PROGRAM RELATED RECEIVABLE - VISIBLE PICTURES 250000 C PROGRAM RELATED RECEIVABLE - IBEX 237923 C PROGRAM RELATED RECEIVABLE - CARPENTER'S CODE 390000 C PROGRAM RELATED RECEIVABLE - LOVELADY CENTER 600000 C 6988046 X PART X, LINE 2: IN ACCORDANCE WITH FASB ASC 740, THE FOUNDATION'S POLICY IS TO RECORD A LIABILITY FOR ANY TAX POSITION THAT IS BENEFICIAL TO THE FOUNDATION, INCLUDING ANY RELATED INTEREST AND PENALTIES, WHEN IT IS MORE LIKELY THAN NOT THE POSITION TAKEN BY MANAGEMENT WITH RESPECT TO THE TRANSACTION OR CLASS OF TRANSACTIONS WILL BE OVERTURNED BY A TAXING AUTHORITY UPON EXAMINATION. MANAGEMENT BELIEVES THERE ARE NO SUCH POSITIONS AS OF DECEMBER 31, 2016 AND, ACCORDINGLY, NO LIABILITY HAS BEEN ACCRUED. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS 2499181 0 0 0 0 0 0 2499181 0 2499181 1 0 1 1 1 0 FORM 8621 NOT REQUIRED - SEE PROTECTIVE STATEMENT BELOW PROTECTIVE STATEMENT FILED PURSUANT TO TREASURY REGULATION SECTION 1.1295-3(C) THE FOLLOWING STATEMENT APPLIES TO THE TAXABLE YEAR ENDING DECEMBER 31, 2016 (THE "2016 TAX YEAR") OF IMPACT INVESTING CHARITABLE FOUNDATION (THE "SHAREHOLDER"). THE SHAREHOLDER OWNS 10.719641% OF ONE THOUSAND & ONE VOICES AFRICA FUND I, LP (A CAYMAN PARTNERSHIP) THAT OWNS, THROUGH A DISREGARDED ENTITY, 100 PERCENT OF THE SHARES OF 1K1V HT (PTY) LTD ("1K1V HT"), A SOUTH AFRICA ENTITY TREATED AS A CORPORATION FOR U.S. FEDERAL INCOME TAX PURPOSES. 1K1V HT, IN TURN, OWNS 100 PERCENT OF THE SHARES OF HIGH MOUNTAIN FISHERIES (PTY) LTD, ("HIGH MOUNTAIN"), A LESOTHO CORPORATION TREATED AS A CORPORATION FOR U.S. FEDERAL INCOME TAX PURPOSES. THE PROTECTIVE STATEMENT IS BEING FILED WITH RESPECT TO 1K1V HT AND HIGH MOUNTAIN. (I) THE SHAREHOLDER'S REASONABLE BELIEF STATEMENT: THE SHAREHOLDER REASONABLY BELIEVES THAT 1K1V HT AND HIGH MOUNTAIN, SHOULD NOT BE VIEWED AS A PFIC FOR 1K1V HT'S AND HIGH MOUNTAIN'S TAX YEAR ENDING DECEMBER 31, 2016 BECAUSE OF THE START-UP EXCEPTION OF SECTION 1298(B)(2). SECTION 1298(B)(2) PROVIDES THAT: A CORPORATION SHALL NOT BE TREATED AS A PASSIVE FOREIGN INVESTMENT COMPANY FOR THE FIRST TAXABLE YEAR SUCH CORPORATION HAS GROSS INCOME (HEREINAFTER IN THIS PARAGRAPH REFERRED TO AS THE "START-UP YEAR") IF (A) NO PREDECESSOR OF SUCH CORPORATION WAS A PASSIVE FOREIGN INVESTMENT COMPANY, (B) IT IS ESTABLISHED TO THE SATISFACTION OF THE SECRETARY THAT SUCH CORPORATION WILL NOT BE A PASSIVE FOREIGN INVESTMENT COMPANY FOR EITHER OF THE 1ST 2 TAXABLE YEARS FOLLOWING THE START-UP YEAR, AND (C) SUCH CORPORATION IS NOT A PASSIVE FOREIGN INVESTMENT COMPANY FOR EITHER OF SUCH 2 TAXABLE YEARS. THE SHAREHOLDER BELIEVES THAT 1K1V HT AND HIGH MOUNTAIN SHOULD MEET ALL OF THE AFOREMENTIONED REQUIREMENTS: (1) WITH RESPECT TO THE FLUSH LANGUAGE, DECEMBER 31, 2016 WAS THE FIRST TAXABLE YEAR 1K1V HT AND HIGH MOUNTAIN HAD GROSS INCOME, (2) WITH RESPECT TO (A), K1V HT AND HIGH MOUNTAIN HAD NO PREDECESSOR THAT WAS A PFIC, AND (3) WITH RESPECT TO (B) AND (C), THE SHAREHOLDER BELIEVES K1V HT AND HIGH MOUNTAIN WILL NOT BE A PFIC FOR THE TWO YEARS FOLLOWING THE START-UP YEAR, TAKING INTO ACCOUNT 25 PERCENT OWNED SUBSIDIARIES AS IS REQUIRED UNDER SECTION 1297(C), SINCE HIGH MOUNTAIN IS EXPECTED IN 2017 TO ACQUIRE A SUBSTANTIAL INTEREST IN A CORPORATION THAT CONDUCTS ACTIVE TRADE OR BUSINESS. (II) THE SHAREHOLDER'S AGREEMENT EXTENDING THE PERIODS OF LIMITATIONS ON THE ASSESSMENT OF PFIC RELATED TAXES FOR ALL TAXABLE YEARS TO WHICH THE PROTECTIVE STATEMENT APPLIES. THE SHAREHOLDER CONSENTS TO EXTEND ITS STATUTE OF LIMITATIONS ON COLLECTION OF ALL PFIC RELATED TAXES WITH RESPECT TO 1K1V HT AND HIGH MOUNTAIN FOR THE SHAREHOLDER'S 2016 TAX YEAR AND ALL SUBSEQUENT YEARS TO WHICH A RETROACTIVE QEF ELECTION FOR SHAREHOLDER'S 2016 TAX YEAR WOULD APPLY UNTIL, AT EARLIEST, THREE YEARS FROM THE DATE AN AMENDED TAX RETURN IS FILED PURSUANT TO TREAS. REG. SECTION 1.1295-3(G) FOR SUCH YEARS. SHAREHOLDER ALSO HEREBY ACKNOWLEDGES THAT IT HAS COMPLIED WITH THE REQUIREMENTS SET FORTH IN REG. SECTION 1.1295-3(C)(4), INCLUDING, BUT NOT LIMITED TO, THE REQUIREMENTS RELATED TO WAIVERS MADE BY PARTNERSHIPS. (III) ADDITIONAL INFORMATION AND REPRESENTATIONS: (A) SHAREHOLDER'S NAME, ADDRESS, TAXPAYER IDENTIFICATION NUMBER AND THE SHAREHOLDER'S FIRST TAXABLE YEAR TO WHICH THE PROTECTIVE STATEMENT APPLIES. SHAREHOLDER'S NAME: IMPACT INVESTING CHARITABLE FOUNDATION SHAREHOLDER'S ADDRESS: 6750 W 93RD STREET, OVERLAND PARK, KS 66212 SHAREHOLDER'S TAXPAYER IDENTIFICATION NUMBER: 47-3574130 SHAREHOLDER'S FIRST TAXABLE YEAR TO WHICH THE PROTECTIVE STATEMENT APPLIES: 2016 (B) FOREIGN CORPORATION'S NAME, ADDRESS, AND TAXPAYER IDENTIFICATION NUMBER: FOREIGN CORPORATION'S NAME: 1K1V HT (PTY) LTD. FOREIGN CORPORATION'S ADDRESS: WK WILTON, 9 KINROSS STREET, GERMISTON SOUTH, 1401 SOUTH AFRICA FOREIGN CORPORATION'S TAXPAYER IDENTIFICATION NUMBER: N/A (C) FOREIGN CORPORATION'S NAME, ADDRESS, AND TAXPAYER IDENTIFICATION NUMBER: FOREIGN CORPORATION'S NAME: HIGH MOUNTAIN FISHERIES (PTY) LTD. FOREIGN CORPORATION'S ADDRESS: BLOCK B, MARIE-SELLO OFFICE PARK, ASSISI RD, MASERI LESOTHO, 100 FOREIGN CORPORATION'S TAXPAYER IDENTIFICATION NUMBER: N/A (D) THE HIGHEST PERCENTAGE OF SHARES OF EACH CLASS OF STOCK OF 1K1V HT S.A. AND HIGH MOUNTAIN HELD DIRECTLY OR INDIRECTLY BY THE SHAREHOLDER DURING THE SHAREHOLDER'S TAXABLE YEAR ENDED DECEMBER 31, 2016 WAS 11.287239%. UNDER PENALTIES OF PERJURY, THE AUTHORIZED REPRESENTATIVE OF THE SHAREHOLDER WHO SIGNS THIS TAX RETURN, WHICH IS SUBMITTING THIS STATEMENT, VERIFIES THAT THE INFORMATION CONTAINED IN THIS STATEMENT IS CORRECT TO HIS KNOWLEDGE AND BELIEF, AND THAT HE/SHE HAS AUTHORITY TO SIGN THIS PROTECTIVE STATEMENT ON BEHALF OF THE SHAREHOLDER. SCHEDULE F, PART IV, LINE 1 THE TRANSFERS ARE DISCLOSED ON FORMS 5471 AND 8621. 0 IMPACT INVESTING CHARITABLE TRUST 6750 W 93RD STREET SUITE 100 OVERLAND PARK KS 66212 812375745 501(C)(3) 2375000 FURTHER CHARITABLE PURPOSE OF THE ORGANIZATION MISSION SOUTHSIDE 18335 W 168TH TERRACE OLATHE KS 66062 273655778 501(C)(3) 40000 CHRISTIAN MINISTRY TO SERVE THE POOR ELAM MINISTRIES 5755 NORTH POINT PKWY SUITE 217 ALPHARETTA GA 30022 582134253 501(C)(3) 25000 CHRISTIAN MINISTRY ZOE HOUSE MERCY POINT ADOPTIONS 4350 W 107TH OVERLAND PARK KS 66207 473112561 501(C)(3) 15000 ADOPTIONS NATIONAL CHRISTIAN FOUNDATION NEW MEXICO 1311 TIJERAS AVE NW ALBURQUEQUE NM 87102 850466529 501(C)(3) 38444 CHRISTIAN MINISTRY NATIONAL CHRISTIAN FOUNDATION 11625 RAINWATER DR SUITE 500 ALPHARETTA GA 30009 581493949 501(C)(3) 176509 CHRISTIAN MINISTRY 6 0 X 1 187881 FAIR VALUE X 4 4749506 FAIR VALUE 0 1 0 FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS CRAIG AND APRIL CHAPMAN HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL AND TOP FINANCIAL OFFICIAL EACH REVIEW THE FORM 990 PRIOR TO ITS FILING WITH THE IRS. A COPY OF THE FINAL FORM 990 IS ALSO PROVIDED TO THE VOTING MEMBERS OF THE ORGANIZAION'S GOVERNING BODY PRIOR TO ITS FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES THAT EACH MEMBER ANNUALLY PROVIDE A STATEMENT DISCLOSING ANY POTENTIAL CONFLICTS OF INTEREST, AND APPROPRIATE ACTION IS TAKEN. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION HAS ADOPTED AN EXECUTIVE COMPENSATION SETTING POLICY APPLICABLE TO ALL DISQUALIFIED PERSONS, INCLUDING THE ORGANIZATION'S EXECUTIVE DIRECTOR/PRESIDENT. UNDER THE POLICY, THE FINANCE AUDIT COMPENSATION COMMITTEE ANNUALLY REVIEWS AND APPROVES THE COMPENSATION LEVELS OF THE EXECUTIVE DIRECTOR/PRESIDENT AND OTHER OFFICERS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION PROVIDES, UPON REQUEST, COPIES OF ITS ARTICLES OF INCORPORATION, BYLAWS, CONFLICT OF INTEREST POLICY, FORM 1023, AND ITS FINANCIAL STATEMENTS. FORM 990, PART XI, LINE 9: SHARE OF C CORP NET LOSS -14,912. 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