Joan Burrows returns to her hometown for her niece's graduation, only to be confronted by the serial killer she thought she offed years ago -- after he kidnapped and tormented her and killed her best friend.
The film begins with Joan Burrows (Angela Bettis) jogging home one day. She has flashbacks of her younger self as a little girl (Brittney Wilson) being tortured. The person torturing her cuts open her cheek, which has left a scar. Joan drives to her home town to see her older brother Jeff (Christopher Titus), who is the town sheriff. He phones her while she is on her way and tells her he will see her that night. After the call finishes, he catches his teenage daughter Olympia (Kirby Bliss Blanton) and her friend Sandra (Monika Mar-Lee) speeding and warns them.
Joan drives up to a funeral home, and puts some flowers on a grave. She has a flashback to her younger self and her friend Susie (Tegan Moss) at the graveyard. They decide to go and spy on the undertaker, who they have a crush on. Later that night, Olympia is at a party, and goes to talk to Paul (Devon Graye), who she has a crush on. She is approached by her slutty friend April (Kristin Kowalski) and her boyfriend Howard (Brandon Jay MacLaren) who are looking for April. Paul offers Olympia drugs, and slips his hand into her pocket, taking her phone. He shows her the trick to how he does it.
April and Howard decide to go to the lake and have sex, meanwhile Joan is at home drinking wine and talking to Jeff about his wife. In another flashback, young Joan is at the funeral home with Susie, and the undertaker, Bishop (Ben Cotton). She compliments Bishop's hat, and flirts with him. They are about to kiss, when he does a similar trick to Paul, before chloroforming her. At the lake, Howard strips to his underwear, but leaves April, claiming he cannot have sex with her. She takes off her top, but he walks into the lake instead, causing her to walk away and disappear.
The next day, Olympia, Paul and Sandra are attending a party to see who will be crowned Homecoming queen. Olympia gets crowned, but excitement turns to fear when April's body is found floating in the lake. Later that night, Olympia decides to go to Paul's house and they bond over the fact that both of their mothers are dead. She shows him a scar she got on her leg and her bellybutton piercing. He tells her his dad is ill because he was in the Iraq war.
Meanwhile, Sandra is cleaning her house, when she has an argument with her boyfriend Brian (Carey Feehan). She goes outside to her car, then re-enters the house to find him bleeding on the floor, before being abducted by the killer.
Back at home, Joan has another flashback to how she got her scar. Susie is lying on a slab next to her, with her legs cut open, as Bishop pours a liquid all over her, causing her to scream. He asks Joan's permission to kill Susie, but she refuses. He gets a stapler and staples Joan's stomach, including her bellybutton. He goes back over to Susie and cuts her tongue out before asking Joan if she has had enough.
The next day, Olympia goes to Sandra's house, but finds nobody home. She then discovers Howard's dead body, castrated on the bed. Later that night, Joan comforts her, and is convinced she sees something outside. She looks out, and has another flashback. She begs Bishop to kill Susie, and he breaks her neck.
The next day, Joan is convinced that Bishop is back. She tells Sheriff Delgado (Al Sapienza) about this, and he tells her that Bishop is dead, and they have searched the funeral home from top to bottom. Joan breaks into the funeral home and finds out that it has been turned into a museum about Bishop. She freaks out and the owner calls the police about her. When the police arrive, the owner doesn't press charges on her.
Back at Jeff's house, he tells Olympia that another policeman is outside and will be watching them. Joan goes into the kitchen and cuts some cheese, accidentally cutting her hand open. The blood reminds her of when Bishop cut her hand open. She has a dream where she finds Olympia being tortured by Bishop at the funeral home. She looks over and sees herself on the other slab. She wakes up when someone phones the house. It is Delgado, who tells her there has been no answer on the phone.
Joan gets up to look for Jeff, and finds him with his throat cut in the bathroom. She hears a noise downstairs and grabs the knife used to kill Jeff. She runs outside and is convinced she sees Bishop across the street. She gives chase but the police arrive, and she tells them he is getting away. They see no one, and arrest her because she is covered in blood and holding the murder weapon.
At the station, Joan tells Delgado that the person was wearing a trenchcoat and Bishop's hat. He tells her she saw Bishop because he was inside her head. He tells her she killed Jeff, and asks her where Olympia is. She tells him Olympia and Susie are being tortured. He is surprised at this and she corrects herself by saying she meant Sandra. She then tells him she doesn't know where Olympia is.
He has no choice but to put her in a cell. While she is there, Paul comes to visit her, and is able to free her by doing the phone trick on a policeman and getting the keys to the cell. He believes her innocence and tells her that she needs to rescue Olympia. When Paul leaves, she asks the officer to get her a blanket, and she opens the cell. She opens the door and knocks him out, before escaping to the funeral home with his gun.
Joan breaks in and makes her way down to the basement, where she sees the owner lying dead on the slab. She has another flashback, this time of her cutting herself free with a razor blade, and hitting Bishop with a glass jar. She then sucks out his blood with the embalming machine just to make sure he is dead.
In the present day, Joan breaks into a barn and finds a trapdoor leading to the basement. She gets down there and sees Paul tied up on the floor, with Olympia and Sandra on slabs. When she goes to rescue Olympia, Paul stands up and shocks her with a cattle prod, knocking her out.
Joan awakens, handcuffed to a pole, and sees Paul dressed in Bishop's clothes. He tells her he had respect for Bishop's game, and he tortures people because his father did it in the military. He says that there are only a handful of people at his school that he wouldn't kill. April was snivelling because she wanted extra credit, and he is so much smarter than her, and he wanted to torture her a lot, but Howard only went through one round of torture before he begged him to kill her. He then tells her Sandra is on a roll and got him to torture Howard until he cut his penis off, and she went through five rounds with Brian. When Joan calls him insane, he replies by saying she is the one who is insane because she thought he was Bishop.
He breaks a bottle and uses the glass to cut her face open at her scar. He then slices down Olympia's foot with a razor blade. He reminds Sandra of when she bullied him on their first day of school, before cutting her head open and tearing a chunk of hair out of her head. Sandra tells Olympia to tell Paul to kill her, and she does. Paul puts some latex over her face and suffocates her.
For the next game, its Joan and Olympia. Paul tells Joan that he wants people to believe she is the killer and he arrived and managed to kill her and become the town hero, like she did so many years ago, so he can only torture her using the cattle prod. When Olympia refuses to let him kill Joan, he tears out her bellybutton ring before threatening to drill into her teeth.
Joan grabs a piece of glass and literally slices her thumb off so she can slip out of the handcuffs before grabbing the gun and shooting Paul twice. She gets Olympia free, but Paul sits up, and slices down Joan's leg with a scalpel, so Olympia grabs the drill and drills into his head, killing him.
Later, the two women are at the hospital, where Joan tells Olympia it will all be okay. When Olympia lies down, she sees Paul standing over her. Olympia wakes up, revealing the hospital bit with Paul was a dream. Joan tells Olympia that Paul may be dead, but the pain of what happened to them never truly goes away.