The bright supergiant Betelgeuse (Alpha Orionis, HD 39801) experienced a visual dimming during 2019 December and the first quarter of 2020, reaching an historic minimum 2020 February 7-13. During 2019 September-November, prior to the optical dimming event, the photosphere was expanding. At the same time, spatially resolved ultraviolet spectra using the Hubble Space Telescope/Space Telescope Imaging Spectrograph revealed a substantial increase in the ultraviolet spectrum and Mg II line emission from the chromosphere over the southern hemisphere of the star. Moreover, the temperature and electron density inferred from the spectrum and C II diagnostics also increased in this hemisphere. These changes happened prior to the Great Dimming Event. Variations in the Mg II k-line profiles suggest material moved outwards in response to the passage of a pulse or acoustic shock from 2019 September through November. It appears that this extraordinary outflow of material from the star, likely initiated by convective photospheric elements, was enhanced by the coincidence with the outward motions in this phase of the ∼400 day pulsation cycle. These ultraviolet observations appear to provide the connecting link between the known large convective cells in the photosphere and the mass ejection event that cooled to form the dust cloud in the southern hemisphere imaged in 2019 December, and led to the exceptional optical dimming of Betelgeuse in 2020 February.