SD

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

Form SD

Specialized Disclosure Report

Nobility Homes, Inc.

Florida (State or other Jurisdiction of Incorporation) 000-06506 (Commission File Number) 59-1166102 (I.R.S. Employer Identification No.)

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:

☒ Rule 13p-1 under the Securities Exchange Act (17 CFR 240.13p-1) for the reporting period from January 1 to December 31, 2016.

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, 2016 to December 31, 2016.

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). Most of 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 some of its necessary conflict minerals used in its manufactured homes may have been sourced from a Covered Country. 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 Company’s 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.

Exhibit No.	Description
1.01	Conflict Minerals Report of Nobility Homes, Inc.

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.

	NOBILITY HOMES, INC.
Date: May 30, 2017	By:	/s/ Lynn J. Cramer, Jr.
		Lynn J. Cramer, Jr.
		Treasurer and Principal Accounting Officer

EX-1.01

Exhibit 1.01

Conflict Minerals Report of Nobility Homes, Inc.

in Accordance with Rule 13p-1 under the Securities Exchange Act of 1934

This is the Conflict Minerals Report (the “Report”) of Nobility Homes, Inc. (the “Company”) for calendar year 2016 in accordance with Rule 13p-1 (“Rule 13p-1”) under the Securities Exchange Act of 1934, as amended.

The Company undertook due diligence to determine whether any cassiterite, columbite-tantalite, wolframite, gold, and the following derivatives, tin, tantalum and tungsten (conflict minerals), which may be used in the manufacturing of homes had been sourced from the Democratic Republic of the Congo or an adjoining country (Covered Countries). The Company designed its due diligence to provide a reasonable basis for the Company to determine whether any conflicts minerals were sourced from a Covered Country.

The Company has determined in good faith that for calendar year 2016, its conflict minerals status resulting from its due diligence efforts shows a portion to be DRC conflict undeterminable and the remainder to be DRC conflict free. These determinations were made based on the diligence measures described below and on representations made by the Company’s suppliers. This Report has not been subject to an independent private sector audit as allowed under Rule 13p-1.

As a company in the manufactured home business, the Company is several levels removed from the actual mining of conflict minerals. The Company does not make purchases of raw ore or unrefined conflict minerals and makes no direct purchases in the Covered Countries.

The Company’s due diligence measures included sending each supplier that may have provided conflicts minerals a survey that was developed in order to 1) explain conflicts minerals to suppliers, 2) determine whether the supplier used conflicts minerals and 3) if the supplier utilized conflicts minerals, where such minerals originated or whether they were derived from scrap or recycled sources. In an effort to obtain the highest practicable response rate, the Company’s process included follow up communication efforts. The Company received a response from a majority of its suppliers that were sent a survey. The Company reviewed the responses and followed up with certain suppliers to clarify any inconsistencies or incomplete items. As a Company that is not involved in the actual mining or procurement of conflicts minerals, the Company relied on its suppliers’ representations and largely focused on the accuracy and quality of the representations made during the due diligence process to determine whether further inquiry was warranted.

Most of 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 a few suppliers, the source country was undeterminable.

As a result of the due diligence measures described above, the Company has determined that some materials used in its manufactured homes are DRC conflict undeterminable. The Company makes this determination due to a lack of information from its suppliers to conclude whether the conflict minerals originated in the Covered Countries or were from recycle or scrap sources. The Company has no reason to believe that the remaining components of the manufactured homes originated in a Covered Country and, accordingly, determined them to be DRC conflict free.

Steps to Mitigate Risk

We intend to continue conducting due diligence in an effort to mitigate the risk that any Conflict Minerals in our products could benefit armed groups in a Covered Country.

These steps include:

• Continued follow-up to improve the quality of information received from the suppliers that we survey; and

• Continuing to educate our employees and direct suppliers about our reporting obligations imposed by Form SD and the Rule regarding Conflict Minerals.