Suspect in the killing of UnitedHealthcare's CEO struggles, shouts while entering courthouse

Prosecutors were beginning to take steps to bring Mangione back to New York while new details emerged about his life and how he was captured. The 26-year-old Ivy League graduate from a prominent Maryland real estate family was charged with murder hours after he was arrested in the Manhattan killing of Brian Thompson, who led the United States' largest medical insurance company.

At the brief hearing, defense lawyer Thomas Dickey informed the court that Mangione will not waive extradition to New York but instead wants a hearing on the issue. Mangione was denied bail after prosecutors said he was too dangerous to be released.

Mangione, wearing an orange prison jumpsuit, mostly stared straight ahead at the hearing, occasionally consulting papers, rocking in his chair or looking back at the gallery. At one point, he began to speak to respond to the court discussion but was quieted by his lawyer.

A law enforcement bulletin obtained by The Associated Press said that at the time of his arrest, Mangione was carrying a handwritten document expressing anger with what he called "parasitic" health insurance companies and a disdain for corporate greed and power.

He wrote that the U.S. has the most expensive health care system in the world and that profits of major corporations continue to rise while "our life expectancy" does not, according to the bulletin.

In social media posts, Mangione called "Unabomber" Ted Kaczynski a "political revolutionary," according to the police bulletin. Kaczynski carried out a series of bombings while railing against modern society and technology.

Mangione remained jailed in Pennsylvania, where he was initially charged with possession of an unlicensed firearm, forgery and providing false identification to police. Manhattan prosecutors have obtained an arrest warrant, a step that could help expedite his extradition from Pennsylvania.

Mangione was arrested in Altoona, Pennsylvania — about 230 miles (about 370 kilometers) west of New York City — after a McDonald's customer recognized him and notified an employee, authorities said.

Officers found him sitting at a back table, wearing a blue medical mask and looking at a laptop, according to a Pennsylvania police criminal complaint.

He initially gave them a fake ID, but when an officer asked Mangione whether he'd been to New York recently, he "became quiet and started to shake," the complaint says.

When he pulled his mask down at officers' request, "we knew that was our guy," rookie Officer Tyler Frye said.

Images of Mangione released Tuesday by Pennsylvania State Police showed him pulling down his mask in the corner of the McDonald's while holding what appeared to be hash browns and wearing a winter jacket and beanie. In another photo from a holding cell, he stood unsmiling with rumpled hair.

New York Police Commissioner Jessica Tisch said Mangione was carrying a gun like the one used to kill Thompson and the same fake ID the shooter had used to check into a New York hostel, along with a passport and other fraudulent IDs.

NYPD Chief of Detectives Joseph Kenny said Mangione also had a three-page, handwritten document that shows "some ill will toward corporate America."

A law enforcement official who wasn't authorized to discuss the investigation publicly and spoke with The Associated Press on condition of anonymity said the document included a line in which Mangione claimed to have acted alone.

"To the Feds, I'll keep this short, because I do respect what you do for our country. To save you a lengthy investigation, I state plainly that I wasn't working with anyone," the document said, according to the official.

It also had a line that said, "I do apologize for any strife or traumas but it had to be done. Frankly, these parasites simply had it coming."

Thompson, 50, was killed last Wednesday as he walked alone to a Manhattan hotel for an investor conference. Police quickly came to see the shooting as a targeted attack by a gunman who appeared to wait for Thompson, came up behind him and fired a 9 mm pistol.

Investigators have said "delay," "deny" and "depose" were written on ammunition found near Thompson's body. The words mimic "delay, deny, defend," a phrase used to criticize the insurance industry.

From surveillance video, New York investigators determined the shooter quickly fled the city, likely by bus.

A grandson of a wealthy, self-made real estate developer and philanthropist, Mangione is a cousin of a current Maryland state legislator.

Valedictorian at his elite Baltimore prep school, he went on to earn undergraduate and graduate degrees in computer science in 2020 from the University of Pennsylvania, a spokesperson said.

"Our family is shocked and devastated by Luigi's arrest," Mangione's family said in a statement posted on social media late Monday by his cousin, Maryland Del. Nino Mangione. "We offer our prayers to the family of Brian Thompson and we ask people to pray for all involved."

From January to June 2022, Luigi Mangione lived at Surfbreak, a "co-living" space at the edge of touristy Waikiki in Honolulu.

Like other residents of the shared penthouse catering to remote workers, Mangione underwent a background check, said Josiah Ryan, a spokesperson for owner and founder R.J. Martin.

"Luigi was just widely considered to be a great guy. There were no complaints," Ryan said. "There was no sign that might point to these alleged crimes they're saying he committed."

At Surfbreak, Martin learned Mangione had severe back pain from childhood that interfered with many aspects of his life, from surfing to romance, Ryan said.

Mangione left Surfbreak to get surgery on the mainland, Ryan said, then later returned to Honolulu and rented an apartment.

Martin stopped hearing from Mangione six months to a year ago.