When Cartman loses a tooth and finds money under his pillow, he and the boys come up with a plan to get rich off the Tooth Fairy. When they find out there is no Tooth Fairy, they formulate an even sneakier plan. Unfortunately, the tooth business is already well established by a mob-like group of kids. Kyle begins to question his parents' lies, and soon questions even his own reality.

Token teases Cartman about his weight, who then retaliates by throwing a rock back at him. Cartman is convicted of a hate crime and sent to juvenile detention where he experiences life in the big house. In Cartman's absence, Stan, Kyle, and Kenny try to find a replacement for him so they can win a sled race against the girls.

Mr. Garrison's class gets a new student named Timmy. Not realizing Timmy is handicapped, Mr. Mackey suspects he has ADD and excuses him from school work. When the other kids see this, they claim to have ADD too. Soon, every kid in South Park is on Ritalin. Timmy becomes the lead singer of local band, Lords of the Underworld, which offends singer Phil Collins.

The boys see the Contorting Quintuplets from Romania perform, and they are impressed by the amount of money an act like this brings in, so they try to start their own circus. Soon, the quints and their grandmother defect and are invited to stay at Stan's house. In the meantime, Kenny takes singing lessons and becomes famous in Romania.

Cartman thinks he is too mature for his friends, so logs onto the Internet to find some adult companionship. He joins the North American Man Boy Love Association, and soon has an older friend who is looking for a special relationship with him. Not to be outdone, the other boys soon find older friends, too. Kenny discovers that his mom is pregnant, and tries to make her have an abortion.

Kyle becomes sick and needs a kidney transplant, but his mother is convinced that natural cures from a New Age store are better. Kyle's condition gets worse, and it turns out that the only person who is a compatible kidney donor for Kyle is Cartman, and Cartman's not letting his kidney go without a fight. Meanwhile, Mr. Garrison is on forced leave from the school, and sets out to write a romance novel.

Chef thinks the South Park flag is racist and should be changed, but Jimbo claims the flag should be kept and valued for its history. Chef becomes so angry that he converts to Islam and changes his name. When the school gets in on the debate, Wendy and Cartman are assigned to work together. Oddly, Wendy becomes attracted to Cartman.

Cartman and the boys put together a boy band called Fingerbang. When Stan's dad hears about the musical group, he tries to prevent Stan from being a part of it. As Stan tries to figure out why his dad is acting so strangely, the rest of the guys wait for him at the mall where they're late for their first gig.

When Stan, Cartman, and Kenny are in church, they learn that to avoid hell, you must confess your sins. This frightens the boys, and they are concerned that since Timmy can only say his own name, he won't be able to confess and go to heaven. When they find out the priest is completely immoral, the kids decide to save themselves. Meanwhile, Satan agonizes over his choice to either stay with Chris or get back together with Saddam.

The boys start their own church to save everyone, with Cartman as the preacher. Kenny calls Cartman from Mexico, but Cartman thinks he's calling from hell, so he writes a sermon about it to inspire fear. Jesus is upset that Cartman is taking advantage of people. Back in hell, Satan is having more trouble with Saddam and Chris, so he goes to God for advice.

When the boys finally get to fourth grade, they begin to feel nostalgic for third grade. They get a couple of college students to morph Timmy's wheelchair into a time machine so they can go back. Meanwhile the new fourth grade teacher, Ms.Choksondik, seeks Mr. Garrison's advice for dealing with the boys, and Mr. Garrison attempts to come to terms with his own sexuality.

Cartman gets a fancy new Trapper Keeper, and finds himself stalked by a man who appears to be Bill Cosby. The boys learn the Trapper Keeper has evil plans to take over the world by linking to computer systems. Meanwhile, Ike begins kindergarten, but his class has difficulties electing a class president.

The fourth grade class is preparing a Thanksgiving play about Helen Keller. They want to out-perform the kindergarten class, so they feel pressure to produce a spectacular musical. Timmy chooses a special turkey (named Gobbles) to perform with him, and they form a close bond - but the professional turkey that the theater director hires refuses to work with Gobbles.

Pip gets a job at the Havesham Estate and meets Estella, the girl of his dreams. Estella continuously rejects Pip, so he goes to London to become a gentleman. When he returns to the estate, he learns that Estella is part of a plan to get revenge on the male race.

Cartman is sent to Fat Camp, and returns home looking slim and fit, but one else at Fat Camp is losing any weight. Kenny eats disgusting things for money, and because he is willing to do crazy stunts, he gets his own television show. Mrs. Crabtree's uterus becomes the setting for an unusual pay-per-view event.

Kyle's parents forbid him to go to a concert, so on Cartman's advice he calls the police and tells them his parents molested him. The other kids notice Kyle enjoying the freedom he has with his parents in jail, so they all do the same. Soon, the adults are all in jail and the town is controlled by children - something that is very spooky to a couple whose car breaks down in South Park.

When Mr. Hankey doesn't show up at Christmas time, the boys track him down and see he's lost his faith. The boys are determined to restore the Christmas spirit through a cartoon they make. Mr. Hankey struggles to get the old drive-in cleaned up so the boys can use it for their cartoon, and gets his family to help.