To determine the S&P-adjusted debt-to-EBITDA ratio for Acea S.p.A. for the fiscal year ended December 31, 2022, we apply the standard S&P corporate methodology for Regulated Utilities (as Acea is an Italian multi-utility primarily engaged in regulated water and electricity distribution). 

**Step 1: Estimate Adjusted Debt**
Based on the provided formula:
*Adjusted_Debt = reported_debt + leases + pension_deficit + guarantees + hybrid_debt_portion + other_debt_like_items - eligible_cash*

*   **Reported Debt:** This includes both current and non-current financial liabilities.
    *   Other Noncurrent Financial Liabilities = €4,722,263,000
    *   Other Current Financial Liabilities = €619,418,000
    *   *Total Reported Debt* = €5,341,681,000 (Under IFRS 16, lease liabilities are typically already capitalized and included within these financial liability figures).
*   **Pension Deficit:** S&P treats post-retirement benefit obligations as debt-like. 
    *   Noncurrent Provisions For Employee Benefits = €112,989,000
*   **Eligible Cash:** We use the available cash and cash equivalents. We do not net "Other Current Financial Assets" as a large portion of it consists of related-party receivables which are ineligible for netting under S&P guidelines.
    *   Disponibilità Liquide E Mezzi Equivalenti (Cash and equivalents) = €559,908,000

*Adjusted Debt* = 5,341,681,000 + 112,989,000 - 559,908,000 = **€4,894,762,000**

**Step 2: Estimate Adjusted EBITDA**
Based on the provided formula:
*Adjusted_EBITDA = EBITDA + adjustment_leases + nonrecurring_losses - nonrecurring_gains ± pension_adjustments ± joint_venture_proportional_EBITDA ± other_normalization_adjustments*

*   **Reported EBITDA:** In Italian IFRS taxonomies, EBITDA maps to "Gross Profit" (Margine Operativo Lordo).
    *   Gross Profit = €1,305,021,000 
    *(Check: Operating Profit [€565,851,000] + Depreciation/Amortization [€625,799,000] + Impairment [€113,370,000] approx. equals the Gross Profit)*
*   **Joint Venture / Equity Investments:** For utilities, S&P typically adjusts EBITDA to include cash dividends received from equity-accounted investments. 
    *   Dividends Received Classified As Investing Activities = €3,381,000

*Adjusted EBITDA* = 1,305,021,000 + 3,381,000 = **€1,308,402,000**

**Step 3: Calculate the Ratio**
*Adjusted_Debt / Adjusted_EBITDA* = 4,894,762,000 / 1,308,402,000 ≈ 3.7410

<answer>3.74</answer>