AP PHOTO This still image from surveillance video obtained by the Associated Press shows the suspect, left, sought in the the killing of UnitedHealthcare CEO Brian Thompson, center, outside a Manhattan hotel where the health insurer was holding an investor conference, Wednesday.

Brian Thompson’s death Wednesday ended a meteoric life trajectory which saw a boy nurtured in the rural expanse of Hamilton County rise to the job of chief executive of the one of the nation’s largest insurers.

That was punctuated with two brutal shots heard all across America.

Thompson, 50, was shot in the back on a midtown Manhattan street.

Security video of the event shows a shooter poised with a firearm fitted with what is apparently a silencer several feet behind the unsuspecting Thompson as he departed a New York City hotel.

Police said the shooter then fled the scene on foot before mounting an e-bike and escaping into New York’s huge Central Park.

Thompson was the son of the late Dennis Thompson and his wife, Pat, and was valedictorian of South Hamilton High School’s class of 1993.

New York City police say it was a targeted killing.

Thompson had worked at UnitedHealthcare for 20 years and had run health care giant UnitedHealth Group Inc.’s insurance business since 2021. It provides health coverage for more than 49 million Americans and brought in $281 billion in revenue last year.

Thompson’s $10.2 million annual compensation made him one of the company’s highest-paid executives.

His public death was a sharp contrast to his earliest days.

“Brian Thompson was raised southeast of Stanhope. He was recognized as a great student, athlete and friend to everyone at South Hamilton,” Rick Young, Hamilton County supervisor said Wednesday.

“His parents spent a lifetime serving the professional community of Stanhope. They would quietly show up to volunteer and donate to anyone in need, never expecting any recognition. The Thompson family has always epitomised the small town values we all hold dear. The communities of Stanhope and South Hamilton send our thoughts and prayers.”

Heather Holm, South Hamilton’s superintendent, issued the following statement:

“The South Hamilton Community School District is deeply saddened and shocked by the death of Brian Thompson, a beloved member of our school community and 1993 valedictorian. Early Wednesday morning, Brian was the victim of a shooting in midtown Manhattan. He was the CEO of UnitedHealthcare.

“During his time at South Hamilton, Brian was a star student, athlete, homecoming king, and a respected leader. His achievements and character left a meaningful legacy within our schools and community.

“Our thoughts and heartfelt condolences are with his family, friends, and colleagues during this incredibly difficult time. Our community grieves his loss and honors the lasting contributions he made to those who knew him.

“We join all who are mourning in remembering Brian’s life and legacy.”

Thompson’s wife, Paulette Reveiz Thompson, grew up in Webster City.

Wednesday’s targeted fatal shooting thrust the executive and his business into the national spotlight.

As CEO of UnitedHealthcare, Thompson led a firm that provides health coverage to more people than the population of Spain. United is the largest provider of Medicare Advantage plans, the privately run versions of the U.S. government’s Medicare program for people age 65 and older. The company also sells individual insurance and administers health-insurance coverage for thousands of employers and state-and federally funded Medicaid programs.

The business run by Thompson brought in $281 billion in revenue last year, making it the largest subsidiary of the Minnetonka, Minnesota-based UnitedHealth Group.

The University of Iowa graduate began his career as a certified public accountant at PwC and had little name recognition beyond the healthcare industry. Even to investors who own its stock, the parent company’s face belonged to CEO Andrew Witty, a knighted British triathlete who has testified before Congress.

When Thompson did occasionally draw attention, it was because of his role in shaping the way Americans get health care.

At an investor meeting last year, he outlined his company’s shift to “value-based care,” paying doctors and other caregivers to keep patients healthy rather than focusing on treating them once sick.

“Health care should be easier for people,” Thompson said at the time. “We are cognizant of the challenges. But navigating a future through value-based care unlocks a situation where the … family doesn’t have to make the decisions on their own.”

Thompson also drew attention in 2021 when the insurer, like its competitors, was widely criticized for a plan to start denying payment for what it deemed non-critical visits to hospital emergency rooms.

“Patients are not medical experts and should not be expected to self-diagnose during what they believe is a medical emergency,” the chief executive of the American Hospital Association wrote in an open letter addressed to Thompson. “Threatening patients with a financial penalty for making the wrong decision could have a chilling effect on seeking emergency care.”

United Healthcare responded by delaying rollout of the change.

Thompson, who lived in a Minneapolis suburb and was the father of two high-school students, was set to speak at an investor meeting in a midtown New York hotel. He was on his own and about to enter the building when he was shot in the back by a masked assailant who fled on foot, the New York Police Department said.

Chief of Detectives Joseph Kenny said investigators were looking at Thompson’s social media accounts and interviewing employees and family members.

“Didn’t seem like he had any issues at all,” Kenny said. “He did not have a security detail.”

“He’s a good kid,” a family friend who asked not to be identified said. “It’s just a mess.”

Associated Press reporters Adam Geller, Tom Murphy, Michael R. Sisak and Steve Karnowski contributed to this report.