5 1 js552901.txt FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 5 ANNUAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 1. Name and Address of Reporting Person James R. Simmons c\o Nadeau & Simmons, P.C. 1250 Turks Head Building Providence, RI 02903 2. Issuer Name and Ticker or Trading Symbol Providence Capital V, Inc. Ticker or Trading Symbol: N/A 3. IRS or Social Security Number of Reporting Person (Voluntary) N/A 4. Statement for Month/Year 2000 5. If Amendment, Date of Original (Month/Year) N/A 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) (X) Director (X) 10% Owner (X) Officer (give title below) ( ) Other (specify below) Vice President 7. Individual or Joint/Group Filing (Check Applicable Line) (X) Form filed by One Reporting Person ( ) Form filed by More than One Reporting Person

PROVIDENCE CAPITAL V INC 5