Specialized Disclosure Report (sd)
May 28 2021 - 8:31AM
Edgar (US Regulatory)
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Form SD
Specialized Disclosure Report
Nobility
Homes, Inc.
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Florida
(State or other Jurisdiction of
Incorporation)
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000-06506
(Commission File Number)
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59-1166102
(I.R.S. Employer
Identification No.)
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3741 S.W. 7th Street
Ocala, Florida 34474
(352) 732-5157
(Principal
Executive Office) (Zip Code)
Lynn J. Cramer, Jr.
Treasurer and Principal Accounting Officer
(352) 732-5157
(Name and
telephone number, including area code, of person to contact in connection with this report)
Check the appropriate box to
indicate the rule pursuant to which this form is being filed, and provide the period to which the information in this form applies:
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☒
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Rule 13p-1 under the Securities Exchange Act (17 CFR 240.13p-1) for the reporting period from January 1 to
December 31, 2020.
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Section 1 Conflict Minerals Disclosure
Item 1.01 Conflict Minerals Disclosure and Report
Conflicts Minerals Disclosure
This Form SD of Nobility
Homes, Inc. (the Company) is filed pursuant to Rule 13p-1 promulgated under the Securities Exchange Act of 1934, as amended, for the reporting period January 1, 2020 to December 31, 2020.
The Company performed a reasonable country of origin inquiry, in which it surveyed suppliers regarding whether the materials or products provided by the
suppliers contained cassiterite, columbite-tantalite, wolframite, gold, and the following derivatives, tin, tantalum and tungsten (Conflict Minerals), and whether such minerals had been sourced from the Democratic Republic of the Congo
or an adjoining country (Covered Countries). The responses the Company received indicated that the Conflict Minerals in the suppliers components and materials either did not originate from a Covered Country or, due to the
uncertainty of certain suppliers, the source country was undeterminable.
During its reasonable country of origin inquiry, the Company determined
that the source of some of its necessary Conflict Minerals used in its manufactured homes could not be identified and as a result may have been sourced from a Covered Country and accordingly should be considered DRC conflict undeterminable. The
Conflict Minerals Report includes a discussion of the due diligence procedures performed and the disclosures required by the Securities and Exchange Commission.
A copy of the Companys Conflict Minerals Report is provided as Exhibit 1.01 to this Form SD and is publicly available at
www.nobilityhomes.com.
Item 1.02 Exhibit
As specified in Section 2, Item 2.01 of this Form SD, the Company is hereby filing its Conflict Minerals Report as Exhibit 1.01 to this report.
Section 2 Exhibits
Item 2.01
Exhibits
The following exhibit is filed as part of this report.
SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the duly
authorized undersigned.
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NOBILITY HOMES, INC.
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Date: May 28, 2021
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By:
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/s/ Lynn J. Cramer, Jr.
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Lynn J. Cramer, Jr.
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Treasurer and Principal Accounting Officer
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