Actually, it turns out that when FM executes the SQL, it factors in whitespace, whereas DBVisualizer (not sure about other database browser apps, but I would assume it's the same) do not. Also, since the TRIM() function isn't supported by MSSQL (from what I've seen, at least) it is necessary to make the query inside of the ExecuteSQL statement something like:
SELECT COUNT(DISTINCT(LTRIM(RTRIM(IMV_ItemID)))) FROM IMV
Weird, but it works!