These four unnamed demons guarded the emergency entrance of Northern Indiana State Hospital.
For reasons unknown, these four demons stood guard outside the hospital, possibly in hopes of killing Sam Winchester who was a patient there. Two of them posed as security guards, a third posed as a patient bound to a wheelchair, and a fourth stood close in the guise of an orderly.
To the surprise of one of them, Castiel, an angel believed to be dead, arrived at the scene. Although unaware what to do at first, Castiel placed his hand on this demon's forehead and instantly smote him. The patient demon stood up and charged at Castiel with the orderly demon, but both were easily caught and killed.
The fourth tried to make a run for it but Castiel appeared before him, told him running wouldn't save him, and killed him too. Throughout the entire incident, Castiel gradually regained his suppressed memories.