Through the use of black magic, Sue-Ann Le Grange was able to harness this reaper to bend to her will. She used him to turn her husband Roy Le Grange into a faith healer, by killing those she saw as immoral and giving their life force to people she deemed worthy of living life.
After Roy Le Grange lays hands on Dean Winchester to heal him, Dean collapses on the stage. When he comes to he sees Roy is standing above him, hands out from his sides, palms up, looking happy. Beside Roy he sees the Reaper, a tall man in a black suit with white hair, very white and extremely wrinkled skin come into focus. He stares at Dean then turns away and vanishes.
As Sam and Dean are learning that Le Grange is trading one life for another to heal people, specifically using a reaper. The Reaper appears chasing after a woman on a jog. The woman attempts to flee, exhausted, she looks behind her again, seeing the Reaper. When she turns forward she crashes into him and falls to he knees. The Reaper lays his hand on the side of her face. Her eyes glaze, killing her at the same moment Roy Le Grange is healing an old man. The Reaper, invisible to the crowd, places his hand beside Roy's on the old man's head. The man rises from his wheelchair and falls to his knees. The color returns to his face and he slowly removes his oxygen tube, eliciting the crowd to gasp and cheer.
When Sam learns how victims are being chosen, he tells Dean not to let Le Grange heal anyone until he tracks down the next intended victim. Sam searches the car park, and hears a man, David Wright, screaming for help. He goes to him, Sam attempts to protect him to no avail a the Reaper gets to Wright and holds his hand to Wright's face. Suddenly he stops, looking confused and rises; due to Dean realizing Sue-Ann is the one control the Reaper, stopping her from completing her ritual. The Reaper stares at Wright lying on the ground gasping for breath, then turns away and vanishes.
Dean is heading toward the tent when some lights go out. He stops, looking behind him, and watches the line of lights lighting the path go out one by one. He turns back to see the Reaper walking toward him. The Reaper places his hand on the side of Dean's head, causing him to convulse. Sue-Ann is reciting, holding up the cross, when Sam appears, grabs it and throws it aside, breaking a glass bottle of blood. The Reaper stops what he is doing and looks up. Dean falls to the ground gasping. Outside, Sue-Ann looks up and sees the Reaper, smiling at her. Terrified, she rises and turns to run, but the Reaper is there in front of her. He places his hand on her head, her eyes glaze over and she falls to her knees. After a moment, still smiling, he allows her to slip to the ground where she convulses twice and dies as the Reaper watches, with a look of satisfaction.